Combination of positional therapy with positive airway pressure for titration in patients with difficult to treat obstructive sleep apnea

Goyal, Abhishek; Pakhare, Abhijit; Subhedar, Rashmi; Khurana, Alkesh Kumar; Chaudhary, Poonam

doi:10.1007/s11325-021-02291-6

Cited by 8 publications

(2 citation statements)

References 17 publications

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“… 28 So in our opinion OSA should be ruled out in COVID19 ARDS survivors with these complaints and if moderate-severe OSA is present, it should be treated with Continuous Positive Airway Pressure (CPAP) therapy. 29 , 30 …”

Section: Discussionmentioning

confidence: 99%

Obstructive sleep apnea is highly prevalent in COVID19 related moderate to severe ARDS survivors: findings of level I polysomnography in a tertiary care hospital

et al. 2022

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Study Objectives Studies have found Obstructive Sleep Apnea (OSA) as a risk factor for increased risk for COVID19 Acute respiratory Distress Syndrome (ARDS); but most of the studies were done in already known patients of OSA. This study was done to find prevalence of OSA in patients with COVID-19 related acute respiratory distress syndrome. Methodology A hospital based longitudinal study was conducted among COVID 19 Intensive Care Unit (ICU) survivors. All consecutive COVID19 with moderate to severe ARDS were evaluated for OSA by Level I Polysomnography (PSG) after 4-6 weeks of discharge. Prevalence of OSA and PSG variables {Total sleep time, Sleep efficiency, sleep stage percentage, Apnea Hypopnea Index (AHI), T90, nadir oxygen} was estimated. Results Out of 103 patients discharged from ICU during study period (October 2020 to 15 December 2020), 67 underwent Level I PSG. Mean Age was 52.6±10.9 years and mean Body Mass Index was 27.5 ± 6.2 Kg/m 2 . Total sleep time was 343.2 ± 86 minutes, sleep efficiency was 75.9±14.2%. OSA (AHI ≥5) was seen in 65/67 patients and 49 patients had moderate to severe OSA (i.e. AHI ≥ 15). Conclusion Moderate-severe OSA was highly prevalent (73%) in COVID19 moderate to severe ARDS survivors. Role of OSA in pathophysiology of COVID19 ARDS needs further evaluation.

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Section: Discussionmentioning

confidence: 99%

Obstructive sleep apnea is highly prevalent in COVID19 related moderate to severe ARDS survivors: findings of level I polysomnography in a tertiary care hospital

et al. 2022

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“…Thinking from pathophysiological plane and biological intuitive logic, there may be several attributes which in different permutation-combinations may optimize the candidature for CPAP/AutoPAP or Bi-level PAP. [ 4 ] To the best of our knowledge, we do not have any evidence till date that is driven clinically to provide meaningful cut-off for predictive variables for Bi-level PAP prescription. The clinical implication of knowing these predictors beforehand may be translated into a more vigilant follow up of those patients who may require bi-level PAP with higher odds by priority triaging them.…”

Section: Introductionmentioning

confidence: 99%

Predictive factors for CPAP failure in obstructive sleep apnea patients

Goyal

Joshi²,

Mitra³

et al. 2021

Lung India

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Objectives: Some patients with obstructive sleep apnea (OSA) do not respond to Continuous Positive Airway Pressure (CPAP) and for these patients, Bi-level PAP is the next level modality. This study by a theory driven hierarchical approach, tries to identify the predictors for CPAP failure among OSA patients. Methodology: The potential predictors for the model were identified from a theoretical framework rooted in clinical examination, laboratory parameters, and polysomnographic variables pertaining to OSA patients. All patients of OSA who underwent manual titration with CPAP or Bi-level PAP (in case of CPAP Failure) between June 2015 and October 2017 were included in model building. This study compared five competitive models blocks deliberated by increasing order of diagnostic complexity and availability of resources. The fitting of the model was determined by both internal and external validation. Results: Among the five competitive models, the selected model has the significant deviance reduction (−2LL = 121.99, X 2 = 25.55, P < 0.0001) from the baseline model (−2LL = 217.356). This logistic regression model consists of the following binary predictors – Age >60 years (odds ratio [OR] = 3.23 [1.27–8.23]), body mass index >35 Kg/m 2 (OR = 4.25 [1.78–10.13]), forced expiratory volume <60% (OR = 7.33 [2.83–18.72]), apnea-hypopnea index >75 (OR = 4.31 [1.61–11.56]) and T90 > 30% (OR = 6.67 [2.57–17.36]). Conclusion: These five factors (acronym as BIPAP) may aid to the clinical decision-making by predicting failure of CPAP and therefore may assist in more vigilant clinical care.

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Only Apnea-Hypopnea Index? What Else to Look For?

Mortari

2023

Clinical Cases in Sleep Physical Therapy

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Combination of positional therapy with positive airway pressure for titration in patients with difficult to treat obstructive sleep apnea

Cited by 8 publications

References 17 publications

Obstructive sleep apnea is highly prevalent in COVID19 related moderate to severe ARDS survivors: findings of level I polysomnography in a tertiary care hospital

Obstructive sleep apnea is highly prevalent in COVID19 related moderate to severe ARDS survivors: findings of level I polysomnography in a tertiary care hospital

Predictive factors for CPAP failure in obstructive sleep apnea patients

Only Apnea-Hypopnea Index? What Else to Look For?

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