Analyzing Neck Circumference as an Indicator of CPAP Treatment Response in Obstructive Sleep Apnea with Network Medicine

Abstract

We explored the relationship between obstructive sleep apnea (OSA) patients’ anthropometric measures and the CPAP treatment response. To that end, we processed three non-overlapping cohorts (D1, D2, D3) with 1046 patients from four sleep laboratories in Western Romania, including 145 subjects (D1) with one-night CPAP therapy. Using D1 data, we created a CPAP-response network of patients, and found neck circumference (NC) as the most significant qualitative indicator for apnea–hypopnea index (AHI) improvement. We also investigated a quantitative NC cutoff value for OSA screening on cohorts D2 (OSA-diagnosed) and D3 (control), using the area under the curve. As such, we confirmed the correlation between NC and AHI (ρ=0.35, p<0.001) and showed that 71% of diagnosed male subjects had bigger NC values than subjects with no OSA (area under the curve is 0.71, with 95% CI 0.63–0.79, p<0.001); the optimal NC cutoff is 41 cm, with a sensitivity of 0.8099, a specificity of 0.5185, positive predicted value (PPV) = 0.9588, negative predicted value (NPV) = 0.1647, and positive likelihood ratio (LR+) = 1.68. Our NC =41 cm threshold classified the D1 patients’ CPAP responses—measured as the difference in AHI prior to and after the one-night use of CPAP—with a sensitivity of 0.913 and a specificity of 0.859.

Correlation between Neck Circumference and Continuous Positive Airway Pressure among Patients of Obstructive Sleep Apnea

“…These findings were thought to be similar to those of the Agrawal R et al study. 15 In the line of this study Mihaicuta S et al 6 highlighted that the classification performance of neck circumference for CPAP accessibility, using a population cohort of individuals who had been kept referring to sleep health facilities for the assessment and the management of OSA. Our statistical study demonstrated the certain NC cut-off point for accurate treatment and prioritization and identified NC as the best marker that correlates with CPAP therapy.…”

“…5 Since the thickness of the neck is an important predictor of OSA, the neck circumference (NC) measurement has become a common procedure in the recent medical assessments when there has been a suspicion of sleep apnea. 6,7 Furthermore, epidemiological data suggests that a neck circumference of more than or equal to 43 centimeters is a more accurate predictor of the incidence of obstructive episodes than BMI. 6,8 There are nowadays a wide range of treatment choices available to choose from for the efficient management of such disorder.…”

“…6,7 Furthermore, epidemiological data suggests that a neck circumference of more than or equal to 43 centimeters is a more accurate predictor of the incidence of obstructive episodes than BMI. 6,8 There are nowadays a wide range of treatment choices available to choose from for the efficient management of such disorder. 9 Continuous positive airway pressure CPAP, is still considered to be the most successful treatment for sleep apnea, even though it has been used for more than three decades.…”

Relationship of Neck Circumference and Obstructive Sleep Apnea: A Cross-sectional Study in Pakistani Population

“…Many researchers observed that a thick neck was a prognostic of OSA in the global population [25,7,26]. However, in the Pakistani population, NC was not a significant indicator of OSA.…”

Special Issue: The Diagnosis and Management of OSA

“…The article by Dr. Peker and his team provides evidence that improvement in the negative mood symptoms associated with depression was associated with an improvement in the excessive daytime sleepiness reported in coronary artery disease (CAD) patients with sleepy OSA using CPAP treatment, but this association did not exist for cognitive symptoms or for anhedonia and appetite [ 8 ]. Using network analysis, Mihaicuta and his coworkers found that neck circumference (>41 cm) is the best qualitative indicator of CPAP treatment response and that it predicts OSA risk [ 9 ].…”