Effect of simulated altitude during sleep on moderate‐severity OSA

Burgess, Keith R.; Cooper, Jacky; Rice, Anthony J.; Wong, Keith; Kinsman, Tahnee A.; Hahn, Allan G.

doi:10.1111/j.1440-1843.2006.00785.x

Cited by 47 publications

(32 citation statements)

References 21 publications

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“…Our study demonstrated similar findings, but our participants who experienced altitude without PAP had less development of central apnea events than in previous studies, perhaps in part due to the administration of supplemental oxygen (4,7). Participants in the Burgess study ORIGINAL RESEARCH were exposed to simulated altitude over a 4-hour period before the 8-hour sleep study, to allow for greater hypoxic stimulus.…”

Section: Discussionsupporting

confidence: 66%

“…The primary outcome was the AHI. Power analysis and sample size were calculated using data from a previous study (4). Nine participants would sufficiently power the study (b = 0.80) to detect minimally important differences in primary outcome (a = 0.05).…”

Section: Discussionmentioning

confidence: 99%

“…At simulated high altitude, severe OSA not treated with PAP is completely replaced by severe central sleep apnea (CSA) (4). The partial pressure of oxygen of inspired air (PI O 2 ) decreases and hypoxemia increases with ascent (2,5,6).…”

mentioning

confidence: 99%

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Effects of Positive Airway Pressure on Patients with Obstructive Sleep Apnea during Acute Ascent to Altitude

et al. 2015

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Rationale: In acute ascent to altitude, untreated obstructive sleep apnea (OSA) is often replaced with central sleep apnea (CSA). In patients with obstructive sleep apnea who travel to altitude, it is unknown whether their home positive airway pressure (PAP) settings are sufficient to treat their obstructive sleep apnea, or altitude-associated central sleep apnea.Methods: Ten participants with positive airway pressure-treated obstructive sleep apnea, who reside at 1,320 m altitude, underwent polysomnography on their home positive airway pressure settings at 1,320 m and at a simulated altitude of 2,750 m in a hypobaric chamber. Six of the participants were subsequently studied without positive airway pressure at 2,750 m.Measurements and Main Results: At 1,320 m, all participants' sleep apnea was controlled with positive airway pressure on home settings; at 2,750, no participants' sleep apnea was controlled. At higher altitude, the apnea-hypopnea index was higher (11 vs. 2 events/h; P , 0.01), mostly due to hypopneas (10.5 vs. 2 events/h; P , 0.01). Mean oxygen saturations were lower (88 vs. 93%; P , 0.01) and total sleep time was diminished (349 vs. 393 min; P = 0.03). Four of six participants without positive airway pressure at 2,750 m required supplemental oxygen to prevent sustained oxygen saturation (as determined by pulse oximetry) less than 80%. Positive airway pressure also was associated with reduced central sleep apnea (0 vs. 1; P = 0.03), improved sleep time (358 vs. 292 min; P = 0.06), and improved sleep efficiency (78 vs. 63%; P = 0.04).Conclusions: Acute altitude exposure in patients with obstructive sleep apnea treated with positive airway pressure is associated with hypoxemia, decreased sleep time, and increased frequency of hypopneas compared with baseline altitude. Application of positive airway pressure at altitude is associated with decreased central sleep apnea and increased sleep efficiency.

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Section: Discussionsupporting

confidence: 66%

Section: Discussionmentioning

confidence: 99%

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Effects of Positive Airway Pressure on Patients with Obstructive Sleep Apnea during Acute Ascent to Altitude

et al. 2015

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“…The AHI due to obstructive apnea at 60 m, 610 m, and 2750 m was 25.5, 17.3, and 0.5, respectively; the AHI from central apnea was 0.38, 8.1, and 78.8, respectively at the same altitudes. 12 In this report we describe a presumptive diagnosis of HAPE and its successful treatment with nasal CPAP. Additionally, we present longitudinal data to suggest that increasing altitude was associated with 1) a progressive increase in auto-adjusted CPAP, and 2) a progressive marked increase in the number of apneic and hypopneic episodes occurring during nasal CPAP use.…”

Section: Discussionmentioning

confidence: 89%

High Altitude, Continuous Positive Airway Pressure, and Obstructive Sleep Apnea: Subjective Observations and Objective Data

Ginosar

Malhotra

Schwartz

2013

High Altitude Medicine & Biology

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Ginosar, Yehuda, Atul Malhotra, and Eli Schwartz. High altitude, continuous positive airway pressure, and obstructive sleep apnea: Subjective observations and objective data. High Alt Med Biol 14:186-189, 2013.-We report observations made by one of the authors who ascended to the Thorang La pass (5416 m) in the Nepal Himalaya in October 2010, despite moderate-severe obstructive sleep apnea. We report the first recorded use of nasal CPAP to treat high altitude pulmonary edema (progressively severe dyspnea at rest and severe orthopnea, with tachycardia and tachypnea) that occurred at 4400 meters, when snow and darkness made safe evacuation difficult. We also present objective longitudinal data of the effects of altitude on auto-adjusting CPAP delivered via a portable nasal CPAP device, and on the apnea hypopnea index measured during sleep while using the device. OSA may be a risk factor for the development of high altitude pulmonary edema and we suggest that a nasal CPAP device located in high altitude trekking stations may provide an additional or alternative treatment option for managing high altitude pulmonary edema until evacuation is possible.

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“…[1][2][3][4] Overall apnea-hypopnea index (AHI) is higher for individuals with obstructive sleep apnea (OSA), and obstructive events convert to predominately central events at altitude. 5 This degree of respiratory disturbance is corrected in part by moving affected individuals from altitude to sea level. 6 Clinically, our sleep laboratories at altitude have noted increased diffi culty in treating OSA patients with positive airway pressure (PAP).…”

Section: S C I E N T I F I C I N V E S T I G a T I O N Smentioning

confidence: 99%

The Effects of Altitude Associated Central Apnea on the Diagnosis and Treatment of Obstructive Sleep Apnea: Comparative Data from Three Different Altitude Locations in the Mountain West

Pagel

Kwiatkowski²,

Parnes

2011

Journal of Clinical Sleep Medicine

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Study Objectives: This study documents both the incidence and effects of central apnea on diagnosis and treatment of OSA at different altitudes in the Mountain West and substantiates the clinical impression that individuals living at altitude with moderate to severe OSA are signifi cantly more diffi cult to treat with PAP. Methods: Split-night polysomnography was compared between sites for patients with a diagnostic AHI > 15 living at 1421 meters (Site 1; N = 150), at 1808 m (Site 2; N = 150) and at 2165 m (Site 3; N = 142). The quality of PAP titration obtained was rated, based on AASM clinical guidelines, from 1 = optimal to 4 = unacceptable. Patients developing central apneas during PAP therapy (CAI > 5.0) were titrated with an alternative O 2 > CPAP/Bilevel PAP protocol. Results: The mean number of central apneas in the diagnostic portion of studies was signifi cantly higher (p < 0.01) at Sites 2 (19.26) and 3 (12.36) than at Site 1 (3.11). Mean numbers of central apneas/h developing on treatment with PAP varied from 4.8/h at Site 1, to 9.79/h at Site 2, to 19.25/h at Site 3 (p < 0.001). At Site 1, 10.6% had a central apnea index (CAI) > 5.0, while 22% met this criterion at Site 2 and 38.7% at Site 3 (Site 3 vs Site 1, p = 0.01; Site 2 vs Site 1, p = 0.02). Rated titration quality varied signifi cantly between sites. At Site 1, mean titration quality was 1.437 (SD 0.821); for Site 2, 1.569 (SD 0.96), and for Site 3, 1.772 (SD 1.025). Titration quality at Site 3 was signifi cantly worse than at Site 1 (t = 3.22, p < 0.01) and at Site 2 (t = 2.55, p < 0.02). Repeat titration requirement differed signifi cantly (p = 0.025). Analysis of covariance comparing titration across 3 altitude levels, controlling for age, was signifi cant for the effect of altitude (p = 0.017). Utilizing the alternative O 2 > C-PAP/Bi-PAP protocol in patients with CAI > 5.0 developing on PAP treatment, an overall optimal or good titration (AASM criteria) was attained in 75/79 (95%) of titrated patients. Conclusions: This study demonstrates that central apnea becomes signifi cantly more common at increasing altitude in both diagnostic and treatment portions of split-night polysomnography in patients with signifi cant OSA. An apparent exponential increase in the percentage of OSA patients with a CAI > 5.0 occurs with increasing altitude. Altitude associated central apnea has a signifi cant negative effect on the quality of OSA treatment obtained during PAP titration for patients living at the altitudes addressed in this study.

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Effect of simulated altitude during sleep on moderate‐severity OSA

Cited by 47 publications

References 21 publications

Effects of Positive Airway Pressure on Patients with Obstructive Sleep Apnea during Acute Ascent to Altitude

Effects of Positive Airway Pressure on Patients with Obstructive Sleep Apnea during Acute Ascent to Altitude

High Altitude, Continuous Positive Airway Pressure, and Obstructive Sleep Apnea: Subjective Observations and Objective Data

The Effects of Altitude Associated Central Apnea on the Diagnosis and Treatment of Obstructive Sleep Apnea: Comparative Data from Three Different Altitude Locations in the Mountain West

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