Determinants of Continuous Positive Airway Pressure Level for Treatment of Obstructive Sleep Apnea

Miljeteig, Harald; Hoffstein, V.

doi:10.1164/ajrccm/147.6_pt_1.1526

Cited by 136 publications

(139 citation statements)

References 10 publications

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“…There was no difference in BMI between responders and nonresponders at each criterion. Moreover, the additional ROC curves for BMI were not sufficient to predict the outcome of the therapy (AUCs: 0.57-0.64; not significant, detailed data not shown), although higher BMI is a factor that increases baseline AHI and PnCPAP [27,28]. The relatively lower BMI (26 (23-29) kg?m -2 ) of our Japanese sample reminds us of craniofacial effects (e.g.…”

Section: Discussionmentioning

confidence: 77%

Optimal positive airway pressure predicts oral appliance response to sleep apnoea

Tsuiki¹,

Kobayashi²,

Namba³

et al. 2009

Eur Respir J

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Patients with less severe obstructive sleep apnoea (OSA) are usually prescribed oral appliances and/or smaller optimal nasal continuous positive airway pressure (PnCPAP) in nCPAP therapy. We hypothesised that OSA patients with greater PnCPAP would not respond favourably to oral appliances.Oral appliances were inserted in nCPAP users after washing-out the nCPAP effect. Follow-up polysomnography was undertaken with the adjusted oral appliance in place. The predictability of PnCPAP was evaluated with receiver-operating characteristic (ROC) curves.The median baseline apnoea/hypopnoea index (AHI) was reduced with the oral appliance from 36 to 12 events?h -1 in 35 patients. When responders were defined as patients showing a follow-up AHI of ,5 events?h -1 with .50% reduction in baseline AHI, the area under the ROC curve for PnCPAP was 0.76. The best cut-off value of PnCPAP turned out to be 10.5 cmH 2 O with a high negative predictive value (0.93) and a low negative likelihood ratio (0.18). OSA patients with a PnCPAP of .10.5 cmH 2 O are unlikely to respond to oral appliance therapy. This prediction is clinically helpful to both OSA patients and medical personnel in discussing oral appliances as a temporary substitute and/or alternative for nCPAP.

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Section: Discussionmentioning

confidence: 77%

Optimal positive airway pressure predicts oral appliance response to sleep apnoea

Tsuiki¹,

Kobayashi²,

Namba³

et al. 2009

Eur Respir J

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“…All patients fulfilled the CPAP treatment criteria [28]. CPAP was calculated mathematically using the following equation: -5.12 + (0.13 6 body mass index (BMI)) + (0.16 6 neck circumference) + (0.04 6 AHI) [34,35], and pressure was not changed during follow-up. A CPAP humidifier was not used in any patients.…”

Section: Methodsmentioning

confidence: 99%

Effect of an ambulatory diagnostic and treatment programme in patients with sleep apnoea

Andreu¹,

Chiner²,

Sancho-Chust³

et al. 2011

Eur Respir J

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The aim of this study to evaluate the efficacy of a home-based programme on clinical response, continuous positive airway pressure (CPAP) compliance and cost in a population of high pre-test probability of suffering obstructive sleep apnoea syndrome (OSAS).Patients were randomised into the following three groups. Group A: home respiratory polygraphy (RP) and home follow-up; group B: hospital polysomnography and hospital followup; and group C: home RP and hospital follow-up. Evaluation during 6 months included Epworth Sleepiness Scale (ESS), Functional Outcomes Sleep Questionnaire (FOSQ), and daily activity and symptom questionnaires. Compliance was assessed by memory cards (group A) and using an hourly counter (groups B and C).66 patients were included (22 per branch), 83% were males, aged mean¡SD 52¡10 yrs, body mass index 34¡7kg?m -2 , apnoea/hypopnoea index 43¡20 h -1 , CPAP pressure 8¡2 cmH 2 O, with no between-group differences. Clinical response showed an ESS of mean¡SD 15¡3 to 6¡4, a FOSQ of 16¡3 to 18¡2, symptoms of 43¡7 to 25¡7, and activity of 37¡11 to 25¡8. At the end of the study, compliance was: group A 73%, group B 68% and group C 57%. The cost per patient was: group A J590¡43, group B J894¡11 and group C J644¡93 (p,0.001).In conclusion, patients with a high initial probability of having OSAS can be diagnosed and treated in a home setting, with a high level of CPAP compliance and lower cost than using either a hospital-based approach or home RP/hospital follow-up.

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“…In addition, several equations incorporating these variables have been used to predict PnCPAP. [5][6][7][8][9][10][11][12] Although these equations cannot replace the use of proper manual titration to identify PnCPAP, such predictive equations are still useful for determination of the starting pressure of CPAP titration, thereby eliminating the need for frequent changes in pressure …”

mentioning

confidence: 99%

Upper Airway Anatomical Balance Contributes to Optimal Continuous Positive Airway Pressure for Japanese Patients with Obstructive Sleep Apnea Syndrome

Ito

Tsuiki

Namba

et al. 2014

Journal of Clinical Sleep Medicine

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and minimizing the time needed to determine the effective pressure. 13 Among the candidates for predictive variables, BMI may be the most important determinant of PnCPAP, as obesity is clearly associated with an increased risk of developing OSAS.14 However, a considerable number of non-obese patients, especially in Asian populations, develop severe OSAS requiring relatively high PnCPAP. 15 In these patients, craniofacial morphology may play a more prominent role in the pathophysiology of OSAS. 16 Therefore, upper airway morphology should be further considered in addition to obesity when trying to determine PnCPAP in Asian OSAS patients.Japanese OSAS patients have a signifi cantly larger tongue size for any given maxillomandibular size, suggesting that Background: The aim of this study was to examine whether the upper airway anatomical balance, as refl ected by tongue size relative to maxillomandibular size, is related to optimal nasal continuous positive airway pressure (PnCPAP). S C I E N T I F I C I N V E S T I G A T I O N SN asal continuous positive airway pressure (nCPAP) is the most effective therapy for obstructive sleep apnea syndrome (OSAS).1 This therapy can suppress respiratory events, leading to alleviation of OSAS-related symptoms and comorbidities.2,3 However, the optimal nasal continuous positive airway pressure (PnCPAP) for maintenance of upper airway patency can be determined only by in-lab manual titration with simultaneous polysomnography (PSG). Based on the recommendation of the Positive Airway Pressure Titration Task Force of the American Academy of Sleep Medicine, the pressure level of CPAP should be increased until elimination of obstructive respiratory events, respiratory effort-related arousals, and loud or unambiguous snoring. 4 Attending technologists with sufficient skills and experience are required to determine PnCPAP.Previous studies suggested that the PnCPAP could be predicted using several variables, including the apnea-hypopnea index (AHI), oxygen desaturation index, body mass index (BMI), neck circumference, or several craniofacial morphology measures. In addition, several equations incorporating these variables have been used to predict PnCPAP. [5][6][7][8][9][10][11][12] Although these equations cannot replace the use of proper manual titration to identify PnCPAP, such predictive equations are still useful for determination of the starting pressure of CPAP titration, thereby eliminating the need for frequent changes in pressure BRIEF SUMMARYCurrent Knowledge/Study Rationale: In general, obesity requires a higher optimal nasal continuous positive airway pressure (PnCPAP) in obstructive sleep apnea syndrome (OSAS) patients. However, craniofacial factors may be more important for the PnCPAP in Japanese OSAS subjects. Study Impact: The anatomical imbalance (the larger tongue size relative to maxillomandibular dimensions), rather than obesity, was significantly associated with PnCPAP. This fi nding might be specifi c to Japanese OSAS patients.

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Determinants of Continuous Positive Airway Pressure Level for Treatment of Obstructive Sleep Apnea

Cited by 136 publications

References 10 publications

Optimal positive airway pressure predicts oral appliance response to sleep apnoea

Optimal positive airway pressure predicts oral appliance response to sleep apnoea

Effect of an ambulatory diagnostic and treatment programme in patients with sleep apnoea

Upper Airway Anatomical Balance Contributes to Optimal Continuous Positive Airway Pressure for Japanese Patients with Obstructive Sleep Apnea Syndrome

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