Optimal Continuous Positive Airway Pressure Level in Korean Patients with Obstructive Sleep Apnea Syndrome

Choi, Ji Ho; Kim, Eun Joong; Kim, Kang Woo; Choi, June; Kwon, Soon Young; Lee, Heung Man; Kim, Tae Hoon; Lee, Sang Hag; Shin, Chol; Lee, Jun Young

doi:10.3342/ceo.2010.3.4.207

Cited by 21 publications

(25 citation statements)

References 25 publications

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“…5,6,8,9,11 This finding is also compatible with our previous study, in which greater PnCPAP was required to suppress OSAS when a patient had higher AHI. 24 Of note, the present study demonstrated that the balance between the amount of oropharyngeal soft tissue and the craniofacial bony size could predict PnCPAP.…”

Section: Discussionsupporting

confidence: 90%

“…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 upper airway anatomical imbalance may be involved in the pathogenesis in OSAS. [17][18][19] This finding led us to hypothesize that the upper airway anatomical imbalance is more strongly correlated with PnCPAP than BMI in Japanese OSAS patients.…”

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%

mentioning

confidence: 99%

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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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Section: Discussionsupporting

confidence: 90%

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%

mentioning

confidence: 99%

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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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“…After screening the studies, forty-six of them were potentially relevant and the full-text versions were downloaded for detailed evaluation [ 13 – 52 , 55 – 60 ] and four studies were identified after reading the references and they were also downloaded [ 60 – 64 ]. After detailed review of the fifty studies, the authors came to a consensus for twenty-six studies [ 13 – 15 , 19 , 20 , 31 , 32 , 34 , 35 , 38 , 43 – 45 , 47 – 51 , 55 – 61 , 63 , 64 ] which presented equations that met the inclusion and exclusion criteria (see Figure 1 ). There were 4,436 patients in the development phases and 3,489 patients in the validation phases for the combined studies included in this review.…”

Section: Resultsmentioning

confidence: 99%

Mathematical Equations to Predict Positive Airway Pressures for Obstructive Sleep Apnea: A Systematic Review

et al. 2015

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Objective. To systematically review the international literature for mathematical equations used to predict effective pressures for positive airway pressure (PAP) devices. Methods. Google Scholar, PubMed, Scopus, Embase, Web of Science, CINAHL, and The Cochrane Library were searched through June 27, 2015. The PRISMA statement was followed. There was no language limitation. Results. 709 articles were screened, fifty were downloaded, and twenty-six studies presented equations that met the inclusion and exclusion criteria. In total, there were 4,436 patients in the development phases and 3,489 patients in the validation phases. Studies performed multiple linear regressions analyses as part of the equation(s) development and included the following variables: physical characteristics, polysomnography data, behavioral characteristics, and miscellaneous characteristics, which were all predictive to a variable extent. Of the published variables, body mass index (BMI) and mean oxygen saturation are the most heavily weighted, while BMI (eighteen studies), apnea-hypopnea index (seventeen studies), and neck circumference (eleven studies) were the variables most frequently used in the mathematical equations. Ten studies were from Asian countries and sixteen were from non-Asian countries. Conclusion. This systematic review identified twenty-six unique studies reporting mathematical equations which are summarized. Overall, BMI and mean oxygen saturation are the most heavily weighted.

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“…There are numerous studies conducted to designate patients' CPAP pressure levels beforehand to avoid second-night stays and reduce long waiting times. In most of these studies, BMI and AHI were reported to be the most important factors that affected CPAP pressure level and it was reported that optimal CPAP pressure level could be designated beforehand with formulas designed according to these values, enabling initiation of CPAP treatment with these pressure levels [23][24][25]. In these studies, the aim was to designate CPAP pressure level beforehand, according to the respiratory distress index (RDI), oxygen saturation (SaO 2 ), ESS, and BMI.…”

Section: Discussionmentioning

confidence: 99%

Factors That Affect Auto-Continuous Positive Airway Pressure Level Designated During Titration Night in Patients with Obstructive Sleep Apnoea

Salepçi¹,

Parmaksız²,

Kıral³

et al. 2014

Tur Toraks Der

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There is no designated pressure level for continuous positive airway pressure (CPAP) and there are many factors that affect pressure level. In our study, we aimed to assess factors that affect CPAP pressure level on titration night. MATERIAL AND METHODS: Patients who were diagnosed with obstructive sleep apnoea syndrome (OSAS) and who were recommended to use CPAP between January 2005 and June 2011 were included in the study. The files of the patients were investigated retrospectively. All the patients were diagnosed with OSAS by polysomnography (PSG) conducted on the first night and their auto-CPAP titrations were made on a second night by full-night PSG. The patients whose CPAP and BIPAP titrations made manually were excluded. The CPAP pressure level for each patient was set at the minimum pressure needed to abolish all respiratory events in the supine position and at the rapid eye movement (REM) stage. RESULTS: Five hundred and twenty-five patients were included in the study. Three hundred and seventy (70.5%) were men and 155 (29.5%) were women. Mean age was 50.4±9.8 years, body mass index (BMI) was 32.2±5.7, Epworth Sleepiness Scale (ESS) score was 10.6±6, and CPAP pressure level was 10.5±2.1. In the first-night PSG, mean apnoea hypopnoea index (AHI) was 50.1±23.7, oxygen desaturation index (ODI) was 42.7±24.8, minimum oxygen saturation (min SpO 2) was 75.6±10.9%, and periodic leg movement index (PLMI) was 19.6±21.3. No correlation was found between CPAP pressure and age or gender. A positive correlation was found with BMI and ESS score. In the first-night PSG, a positive correlation was found with AHI, AI, ODI, and PLMI, and a negative correlation with min SpO 2 %. In the last-night PSG, a positive correlation was found with sleep latency, full-face mask usage, and PLMI, and a negative correlation with sleep efficiency and nasal mask usage. In multivariate analysis, longer sleep latency and higher PLMI were found to be independent effective factors. CONCLUSION: Although age and gender do not affect CPAP pressure level, higher BMI and ESS and severe OSAS require higher levels of CPAP pressure. Longer sleep latency, lower sleep efficiency, shorter REM latency, and higher PLMI and full-face mask usage on the last night also lead to higher levels of CPAP pressure.

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Optimal Continuous Positive Airway Pressure Level in Korean Patients with Obstructive Sleep Apnea Syndrome

Cited by 21 publications

References 25 publications

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

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

Mathematical Equations to Predict Positive Airway Pressures for Obstructive Sleep Apnea: A Systematic Review

Factors That Affect Auto-Continuous Positive Airway Pressure Level Designated During Titration Night in Patients with Obstructive Sleep Apnoea

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