Upper airway collapsibility in patients with OSA treated with continuous positive airway pressure: a retrospective preliminary study

Bosi, Marcello; Parenti, Serena Incerti; Fiordelli, Andrea; Poletti, Venerino; Bonetti, Giulio Alessandri

doi:10.5664/jcsm.8674

Cited by 7 publications

(2 citation statements)

References 43 publications

(61 reference statements)

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“…Landry et al retrospectively demonstrated that a CPAP value ≤8 cmH 2 O identifies an OSA patient with low Pcrit (<−2 cmH 2 O), who could be selected for a non-CPAP treatment option, UA surgery included [ 17 , 18 ].…”

Section: Sleep Studiesmentioning

confidence: 99%

OSA Upper Airways Surgery: A Targeted Approach

et al. 2021

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Obstructive sleep apnea syndrome (OSA) is a multi-factorial disorder, with quite complex endotypes, consisting of anatomical and non-anatomical pathophysiological factors. Continuous positive airway pressure (CPAP) is recognized as the first-line standard treatment for OSA, whereas upper airway (UA) surgery is often recommended for treating OSA patients who have refused or cannot tolerate CPAP. The main results achievable by the surgery are UA expansion, and/or stabilization, and/or removal of the obstructive tissue to different UA levels. The site and pattern of UA collapse identification is of upmost importance in selecting the customized surgical procedure to perform, as well as the identification of the relation between anatomical and non-anatomical factors in each patient. Medical history, sleep studies, clinical examination, UA endoscopy in awake and drug-induced sedation, and imaging help the otorhinolaryngologist in selecting the surgical candidate, identifying OSA patients with mild UA collapsibility or tissue UA obstruction, which allow achievement of the best surgical outcomes. Literature data reported that the latest palatal surgical procedures, such as expansion sphincter palatoplasty or barbed reposition palatoplasty, which achieve soft palatal and lateral pharyngeal wall remodeling and stiffening, improved the Apnea Hypopnea Index, but the outcome analyses are still limited by methodological bias and the limited number of patients’ in each study. Otherwise, the latest literature data have also demonstrated the role of UA surgery in the improvement of non-anatomical factors, confirming that a multidisciplinary and multimodality diagnostic and therapeutical approach to OSA patients could allow the best selection of customized treatment options and outcomes.

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Section: Sleep Studiesmentioning

confidence: 99%

OSA Upper Airways Surgery: A Targeted Approach

et al. 2021

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“…Indeed, recent reports have linked the optimal PAP requirement to airway collapsibility,[ 16 29 ] a key pathophysiological contributor to OSA severity. [ 30 ] Although some patients with moderate-to-severe OSA experience mild airway collapsibility and have low optimal PAP requirements,[ 31 ] more collapsible airways often lead to more severe OSA. [ 16 32 ] The participants in this study were predominantly males and had increased BMI.…”

Section: Discussionmentioning

confidence: 99%

Optimal positive airway pressure requirement and polysomnography indices of obstructive sleep apnea severity in the Saudi population

Bamagoos

Alshaynawi²,

Gari³

et al. 2023

Annals of Thoracic Medicine

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CONTEXT: Positive airway pressure (PAP) is the first-line therapy for obstructive sleep apnea (OSA). Overnight PAP titration for determining optimal PAP requirements is expensive and often inconvenient. Prediction of optimal PAP requirements from diagnostic polysomnography via mathematical equations is possible but variable across populations. AIMS: We aimed to (1) determine the optimal PAP requirement, (2) determine differences in optimal PAP requirements across OSA severity groups, (3) determine the relationship between optimal PAP requirement and diagnostic polysomnography measurements of OSA severity, and (4) develop a pilot equation to predict the optimal PAP requirement from diagnostic polysomnography in a sample from the Saudi population. METHODS: We analyzed records pertaining to adult OSA patients ( n = 215; 63% of males) who underwent standardized diagnostic and titration polysomnography in our sleep laboratory between 2015 and 2019. Demographic, anthropometric, and clinical information were also collected for the analysis. Inferential statistics were performed for comparisons between diagnostic and titration studies and between OSA severity groups. Regression analyses were also performed to determine the potential predictors of optimal PAP requirements. Data were presented as the mean (± standard deviation) or median (25 th –75 th quartiles) according to normality. RESULTS: The median optimal PAP requirement was 13 (9–17) cmH 2 O. The optimal PAP requirement was significantly greater for male versus female participants (14 [10–17] vs. 12 [8–16] cmH 2 O) and for participants with severe OSA (16 [12–20] cmH 2 O, n = 119) versus those with moderate (11 [8–14] cmH 2 O, n = 63) or mild (9 [7–12] cmH 2 O, n = 33) OSA. When combined, nadir oxygen saturation, oxygen desaturation index, and arousal index could be used to predict the optimal PAP requirement ( R 2 = 0.39, F = 34.0, P < 0.001). CONCLUSIONS: The optimal PAP requirement in the Saudi population is relatively high and directly correlated with OSA severity. Diagnostic polysomnography measurements of OSA severity predicted the optimal PAP requirement in this sample. Prospective validation is warranted.

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Differences in Positive Airway Pressure Requirements in Obstructive Sleep Apnea Between Black and White Patients

Cai,

Parekh,

Rodin

et al. 2024

Otolaryngol.--head neck surg.

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ObjectiveThere are disparities between Black and White patients in the utilization of positive airway pressure (PAP) alternatives for obstructive sleep apnea (OSA). Given low utilization rates among Black patients, there is limited knowledge of PAP alternative outcomes in this group. Therapeutic PAP levels are clinically accessible measures that have been shown to predict PAP alternative outcomes. Herein, we examined differences in PAP requirements between Black and White patients in a large clinical sample.Study DesignCross‐sectional.SettingAcademic sleep center.MethodsWe included OSA patients prescribed autoadjusting PAP between January 2018 and 2020 with baseline apnea‐hypopnea index (AHI) ≥ 10. Mean and 90th percentile PAP levels were compared between White and Black patients who used PAP for ≥1 hour daily using linear regression controlling for age, sex, body mass index (BMI), AHI, oxygen saturation nadir, and mask type.ResultsThere were 157 Black and 234 White patients who were generally obese (BMI, 37.3 ± 8.7) with severe OSA (AHI, 36.9 ± 25.6). Black patients had a 0.68 cm higher (95% confidence interval [CI]: 0.36, 1.35) mean PAP level and 0.85 cm H2O higher (95% CI: 0.36, 1.35) 90th percentile PAP level than white patients. Although statistically significant, differences were small and not clinically meaningful.ConclusionBlack and White OSA patients had clinically insignificant differences in PAP requirements, suggesting comparable upper airway collapsibility. Considering the predictive value of therapeutic PAP levels, our findings suggest Black and White patients may have comparable PAP alternative responses from a collapsibility standpoint. Future studies should explore reasons for low utilization of PAP alternatives among Black patients.

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Upper airway collapsibility in patients with OSA treated with continuous positive airway pressure: a retrospective preliminary study

Cited by 7 publications

References 43 publications

OSA Upper Airways Surgery: A Targeted Approach

OSA Upper Airways Surgery: A Targeted Approach

Optimal positive airway pressure requirement and polysomnography indices of obstructive sleep apnea severity in the Saudi population

Differences in Positive Airway Pressure Requirements in Obstructive Sleep Apnea Between Black and White Patients

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