Baseline Lighter Sleep and Lower Saturation Are Associated With Improved Sleepiness and Adherence on Continuous Rather Than Autotitrating Positive Airway Pressure

2019 ◽  
Vol 51 (3) ◽  
pp. 174-179 ◽  
Author(s):  
R. Bart Sangal ◽  
Nimish Sudan
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Side Effects ◽  
Continuous Positive Airway Pressure ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Arousal Index ◽  
Cpap Titration ◽  
Obstructive Sleep ◽  
Lower Saturation

The objective was to test whether there were better outcomes on switching from autotitrating positive airway pressure (APAP) to continuous positive airway pressure (CPAP) in a clinic sample of patients with obstructive sleep apnea (OSA). Patients prescribed APAP in 2015-2016 and belonging to a subset characterized by side effects, or suboptimal response or adherence, were advised a switch to CPAP following a CPAP titration polysomnography. The main analysis was for improvement (after switch from APAP to CPAP) in (1) sleepiness, wakefulness inability, and fatigue, using change from baseline in the Sleepiness–Wakefulness Inability and Fatigue Test (delta SWIFT), and Epworth Sleepiness Scale (delta ESS), and (2) adherence using percentage of days with ≥4-hour use and whether there was ≥4-hour use on ≥70% days. To determine possible predictors for switching, additional analysis was performed for differences at baseline between patients switching and those staying on APAP. A total of 148 patients were switched from APAP to CPAP and had greater improvement in delta SWIFT (5.2 vs 4.1, P = .004), greater improvement in delta ESS (3.6 vs 2.9, P = .011), and better adherence (79.4% vs 74.3%, P = .006) on CPAP than on APAP. More patients were adherent on CPAP than on APAP (83.1% vs 68.9%, P = .006). Patients switching had higher baseline arousal index and stage N1 sleep, and lower nadir oxygen saturation, than 96 patients not switching. Thus, there is a subset of patients with better outcomes after switching to CPAP than on APAP. Patients with baseline lighter sleep (indicated by more arousals and stage N1), or greater desaturation, may be more likely to do better on CPAP than on APAP. CPAP may be the preferable treatment in a significant subset of patients. If APAP is used first anyway, side effects, or suboptimal response or adherence, should lead to consideration of switching to CPAP based on a CPAP titration polysomnography.

scholarly journals Long-Term Compliance with Continuous Positive Airway Pressure in Patients with Obstructive Sleep Apnea

2008 ◽  
Vol 15 (7) ◽  
pp. 365-369 ◽  
Author(s):  
Norman Wolkove ◽  
Marc Baltzan ◽  
Hany Kamel ◽  
Richard Dabrusin ◽  
Mark Palayew
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Continuous Positive Airway Pressure ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Significant Proportion ◽  
Apnea Hypopnea Index ◽  
Cpap Titration ◽  
Obstructive Sleep

BACKGROUND: Continuous positive airway pressure (CPAP) is an effective treatment for obstructive sleep apnea (OSA). However, compliance is a significant problem and has been incompletely assessed in long-term studies.OBJECTIVE: To assess the long-term compliance of OSA patients with CPAP therapy.SUBJECTS: Eighty patients who had had a diagnosis of OSA at least four years previously and received a written prescription for CPAP were evaluated.METHODS: Subjects were identified by reviewing sleep laboratory records. Participants were contacted by telephone and were asked to quantitate their CPAP use (hours per night, nights per week) and to evaluate whether there had been improvement in symptoms. Those who commenced but subsequently abandoned therapy and those who never initiated treatment were questioned about their reasons for noncompliance.RESULTS: Patient demographics included mean (± SD) age (58±11 years), male sex (70 of 80 patients [88%]) and mean apnea-hypopnea index (70±44 events/h). At the time of the interview (64.0±3.7 months after diagnosis), 43 of 80 patients (54%) were still using CPAP and most reported an improvement in symptoms. Twelve of 80 patients (15%) had abandoned CPAP after using it for 10.1±15.5 months, and 25 of 80 patients (31%) had never commenced therapy after initial diagnosis and CPAP titration. Analysis of scores reflecting initial patient sleepiness revealed a significant association of this symptom with subsequent CPAP compliance.CONCLUSION: Although many patients with OSA derive subjective benefit from, and adhere to treatment with CPAP, a significant proportion of those so diagnosed either do not initiate or eventually abandon therapy. Initial experience with CPAP appears to be important, reinforcing the need for early education and support in these patients.

The Usefulness of Respiratory Mechanic Instability in Evaluating the Effect of Continuous Positive Airway Pressure for Obstructive Sleep Apnea

2019 ◽  
Vol 129 (4) ◽  
pp. 388-393
Author(s):  
Ji Ho Choi ◽  
Jae Yeup Jung ◽  
Ji Eun Moon ◽  
Se-Hwan Hwang
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Continuous Positive Airway Pressure ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Stage Duration ◽  
Cpap Titration ◽  
Obstructive Sleep ◽  
Titration Data ◽  
Respiratory Disturbance

Objectives: Respiratory mechanics instability (RMI) based on paradoxical movement is correlated with respiratory disturbance such as apnea-hypopnea index (AHI) and reflects the severity of obstructive sleep apnea (OSA). The purpose of this study was to identify RMI as a method for assessing the effectiveness of continuous positive airway pressure (CPAP) in the management for OSA. Methods: A total of 71 consecutive OSA patients with CPAP titration were included in this study. We compared sleep (sleep efficiency, arousal index, and sleep stages), respiratory (AHI, oxygen desaturation index ≥3% [ODI3], and lowest oxygen saturation), and RMI parameters (events, index, duration, and % of stage duration) between diagnostic polysomnography and CPAP titration data. Results: All RMI parameters (events [157.5 ± 80.9 vs 80.0 ± 47.1; P < .001], index [25.3 ± 12.4 vs 12.7 ± 7.0; P < .001], duration [182.6 ± 96.2 vs 79.8 ± 88.9; P < .001], and % of stage duration [49.0 ± 24.4 vs 20.5 ± 21.3; P < .001]) were significantly improved by the alleviation of obstructive respiratory disturbance parameters (AHI [45.1 ± 23.0 vs 4.2 ± 4.3; P < .001], ODI3 [44.9 ± 22.6 vs 4.8 ± 4.6; P < .001], and lowest oxygen saturation [77.7 ± 7.3 vs 89.3 ± 3.8; P < .001]) compared to diagnostic polysomnography and CPAP titration data. Conclusion: RMI may be a useful method for evaluating the effect of CPAP in OSA patients.

scholarly journals New Predictive Equation for Optimal Continuous Positive Airway Pressure in Adult Patients with Obstructive Sleep Apnea

2021 ◽  
Author(s):  
Kanokkan Pengsakul ◽  
Krongthong Tawaranurak ◽  
Chuanchom Bumrungsena ◽  
Chitladda Chaimongkol ◽  
Jarurin Pitanupong
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Continuous Positive Airway Pressure ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Prediction Equation ◽  
P Value ◽  
Cpap Titration ◽  
Obstructive Sleep ◽  
Titration Study

Objective: This study aimed to develop and validate a new continuous positive airway pressure (CPAP) prediction equation and compare it with other formulas.Material and Methods: We retrospectively included patients with obstructive sleep apnea who underwent a CPAP titration study between January 2012 and December 2016. All clinical and polysomnographic data were collected. The new prediction equation was developed using the first data set, and the predictability performance was validated using the second data set.Results: Among the 266 enrolled patients, 73.7% were male, and the mean body mass index (BMI) was 30.8±7.4 kg/m2 . Five variables, namely age, BMI, neck circumference (NC), apnea–hypopnea index (AHI), and minimum pulse oxygen saturation (Min SpO2 ), highly correlated with the optimal titration pressure, and were therefore included in the equation, as stated below:Predicted pressure (cm H2 O) = 2.26 + (0.02xAge) + (0.04xBMI) + (0.11xNC) + (0.04xAHI) - (0.04xMin SpO2 )This equation accounted for 54.4% of the variance in predicting the optimal titration pressure (R2 =0.544, p-value <0.001). Its optimal estimation was 62.0% in the validated group. The equation-derived predicted pressure correlated with good agreement with the laboratory-derived optimal titration pressure (r=0.70, 95% CI=0.6335–0.755, p-value<0.001) according to Bland–Altman analysis. Conclusion: Our equation is highly consistent with the CPAP titration study in predicting fixed CPAP pressure, and is thereby beneficial for sleep technicians in establishing a starting pressure for such studies at a sleep laboratory.

scholarly journals Selective Continuous Positive Airway Pressure Withdrawal With Supplemental Oxygen During Slow-Wave Sleep as a Method of Dissociating Sleep Fragmentation and Intermittent Hypoxemia-Related Sleep Disruption in Obstructive Sleep Apnea

2021 ◽  
Vol 12 ◽  
Author(s):  
Anna E. Mullins ◽  
Ankit Parekh ◽  
Korey Kam ◽  
Bresne Castillo ◽  
Zachary J. Roberts ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Continuous Positive Airway Pressure ◽  
Slow Wave ◽  
Airway Pressure ◽  
Slow Wave Sleep ◽  
Positive Airway Pressure ◽  
Arousal Index ◽  
Obstructive Sleep ◽  
Intermittent Hypoxemia

Obstructive sleep apnea (OSA) is considered to impair memory processing and increase the expression of amyloid-β (Aβ) and risk for Alzheimer’s disease (AD). Given the evidence that slow-wave sleep (SWS) is important in both memory and Aβ metabolism, a better understanding of the mechanisms by which OSA impacts memory and risk for AD can stem from evaluating the role of disruption of SWS specifically and, when such disruption occurs through OSA, from evaluating the individual contributions of sleep fragmentation (SF) and intermittent hypoxemia (IH). In this study, we used continuous positive airway pressure (CPAP) withdrawal to recapitulate SWS-specific OSA during polysomnography (PSG), creating conditions of both SF and IH in SWS only. During separate PSGs, we created the conditions of SWS fragmentation but used oxygen to attenuate IH. We studied 24 patients (average age of 55 years, 29% female) with moderate-to-severe OSA [Apnea-Hypopnea Index (AHI); AHI4% &gt; 20/h], who were treated and adherent to CPAP. Participants spent three separate nights in the laboratory under three conditions as follows: (1) consolidated sleep with CPAP held at therapeutic pressure (CPAP); (2) CPAP withdrawn exclusively in SWS (OSASWS) breathing room air; and (3) CPAP withdrawn exclusively in SWS with the addition of oxygen during pressure withdrawal (OSASWS + O2). Multiple measures of SF (e.g., arousal index) and IH (e.g., hypoxic burden), during SWS, were compared according to condition. Arousal index in SWS during CPAP withdrawal was significantly greater compared to CPAP but not significantly different with and without oxygen (CPAP = 1.1/h, OSASWS + O2 = 10.7/h, OSASWS = 10.6/h). However, hypoxic burden during SWS was significantly reduced with oxygen compared to without oxygen [OSASWS + O2 = 23 (%min)/h, OSASWS = 37 (%min)/h]. No significant OSA was observed in non-rapid eye movement (REM) stage 1 (NREM 1), non-REM stage 2 (NREM 2), or REM sleep (e.g., non-SWS) in any condition. The SWS-specific CPAP withdrawal induces OSA with SF and IH. The addition of oxygen during CPAP withdrawal results in SF with significantly less severe hypoxemia during the induced respiratory events in SWS. This model of SWS-specific CPAP withdrawal disrupts SWS with a physiologically relevant stimulus and facilitates the differentiation of SF and IH in OSA.

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