Relative accuracy of algorithm-based prescription of nasal CPAP in OSA

Abstract

Considerable night-to-night variation means that a one-night titration is not very precise and is subject to random variation. A one-night titration has a similar inaccuracy to that resulting from using an algorithm, based on OSA severity and neck circumference. Setting all patients with OSA at 10 cmH2O is little worse.

Prediction formulas for nasal continuous positive airway pressure in patients with obstructive sleep apnea syndrome

“…Stradling et al identified only neck circumference and OSAHS severity as independent predictors of nasal CPAP titration pressures using unattended auto-CPAP devices. They found that the formula-based approach is as good as one-night titration in estimating CPAP pressure, with similar long-term outcomes for patients [7,23]. The same formula was used by West et al, who reported comparable clinical outcomes of three different methods of determining and delivering the CPAP pressure [24].…”

“…As sleep laboratory availability and expense is an issue of concern, several methods that could shorten long waiting lists and lower costs have been suggested. These are split-night studies [3], auto-CPAP titration [4], home sleep diagnostic studies [5], unattended autotitrating home CPAP studies [6] and more recently CPAP prediction formulas [7][8][9][10].In this issue of Sleep and Breathing, Ozen K. Basoglu and colleagues of the Ege University of Turkey in their paper "Determination of new prediction formula for nasal continuous positive airway pressure in Turkish patients with obstructive sleep apnea syndrome" developed and validated a new prediction formula of optimal CPAP in a Turkish population with OSAS and compared the new formula with two previous formulas designed and validated in Caucasian and Asian populations. The new formula utilizes neck circumference (NC) and oxygen desaturation index (ODI).…”

“…Therefore, the purpose of the present study and the rationale for another CPAP prediction formula was to investigate possible ethnicity-related effects, and thus create an improved prediction formula for the estimation of the optimum CPAP pressure. However, this underlying assumption was not proved in the course of this study, as there was no difference in the CPAP pressures between CPAP prediction formulas for Caucasians, Asians and Turkish patients, and the authors conclude that race/ ethnicity may not be an important factor in predicting CPAP levels.In the literature several formulas have been used with varying degrees of success to determine the optimal CPAP pressure [7,10,21,22]. Nahmias et al reported a formula including ideal body weight ratio, respiratory disturbance index (RDI) and nadir oxyhemoglobin saturation [21].…”

“…As sleep laboratory availability and expense is an issue of concern, several methods that could shorten long waiting lists and lower costs have been suggested. These are split-night studies [3], auto-CPAP titration [4], home sleep diagnostic studies [5], unattended autotitrating home CPAP studies [6] and more recently CPAP prediction formulas [7][8][9][10].…”

“…In the literature several formulas have been used with varying degrees of success to determine the optimal CPAP pressure [7,10,21,22]. Nahmias et al reported a formula including ideal body weight ratio, respiratory disturbance index (RDI) and nadir oxyhemoglobin saturation [21].…”