Does CPAP Pressure Predict Treatment Outcome with Oral Appliances?

Dort, Leslie C.; Savard, Nicole; Dort, Erika; Dort, Malcolm; Dort, Joseph C.

doi:10.15331/jdsm.6248

Cited by 9 publications

(10 citation statements)

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“…The results are in accordance with the findings in the previously mentioned studies [ 14 – 16 ]. However, as in the Canadian study [ 16 ], the correlation between CPAP pressures and OA treatment outcome was not as strong as reported in the Japanese and Australian populations [ 14 , 15 ]. There might be several reasons for this.…”

Section: Discussionsupporting

confidence: 93%

“…The Japanese population had a lower BMI and included only males [ 14 ], whereas the Australian population was younger [ 15 ], compared to the present study. In the Canadian study [ 16 ], the patients were in many respects similar to ours. Accordingly, different patient selection might explain the moderate result variation between studies examining the relationship concerning CPAP pressures and OA treatment efficacy.…”

Section: Discussionsupporting

confidence: 59%

“…The fixed pressure level was defined either by manual in-laboratory titration [ 14 ] or the 95th percentile pressure from auto-CPAP [ 15 ] and confirmed to be therapeutic with polysomnography. In the Canadian study [ 16 ], the pressure data were retrieved from a variety of commercially available CPAP machines, mainly of auto-adjusting type, using the 90th percentile pressure. Auto-CPAP devices adjust the treatment pressure based on feedback from various patient measures (airflow, pressure fluctuations, measures of airway resistance), applying the lowest effective pressure to splint the airways open.…”

Section: Discussionmentioning

confidence: 99%

“…A therapeutic CPAP pressure > 10.5 cm H 2 O has been associated with OA treatment failure in a Japanese population [ 14 ], whereas a CPAP pressure ≥ 13 cm H 2 O predicted treatment failure in Australian patients [ 15 ]. In a Canadian study, a therapeutic CPAP pressure ≤ 9 cm H 2 O was associated with OA treatment success [ 16 ]. The two former studies selected data from fixed pressure CPAP users with acceptable adherence, whereas the latter study included both fixed pressure and auto-CPAP users, with 50% of the subjects non-tolerant to previous CPAP.…”

Section: Introductionmentioning

confidence: 99%

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Oral appliance treatment outcome can be predicted by continuous positive airway pressure in moderate to severe obstructive sleep apnea

et al. 2017

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BackgroundStudies show that the therapeutic CPAP pressure is associated with oral appliance (OA) treatment outcome in obstructive sleep apnea (OSA) patients. However, these studies included either CPAP adherent patients using fixed pressure devices, or partly CPAP non-adherent patients using fixed pressure or auto-adjusting (auto-CPAP) devices. In many countries, auto-CPAP is predominately used, and only those non-adherent to therapy need a change to OA. Therefore, studies examining the relationship between CPAP pressures and OA treatment outcome should focus on patients non-adherent to auto-CPAP.PurposeThe purpose of this paper is to assess if CPAP pressures predicted OA treatment outcome in patients non-adherent to auto-CPAP therapy.MethodsThe OA treatment responders and non-responders were defined by two success criteria ((1) AHI < 5; (2) 5 ≤ AHI < 10 and > 50% AHI reduction). Logistic regression analyses were performed for CPAP pressures and baseline variables. ROC curve analyses were used to identify CPAP pressure cutoff values, alone and combined with other explanatory variables, predicting the OA treatment outcome.ResultsEighty-seven patients with moderate or severe OSA were included. Maximum CPAP pressures (CPAPmax) were higher in non-responders by both criteria and were, together with baseline AHI, associated with the OA treatment outcome in multivariate regression analyses. ROC curves identified an optimal CPAPmax cutoff of 12 cm H2O, corresponding to a positive predictive value (PPV) of 0.85 in predicting non-response using criterion 1. A prediction model combining CPAPmax > 12 and baseline AHI ≥ 30 had a PPV of 1.0 for non-response by both criteria.ConclusionsMaximum CPAP pressure was a moderate predictor of OA treatment outcome, but combined with baseline AHI, the ability to identify OA non-responders was high.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 59%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Oral appliance treatment outcome can be predicted by continuous positive airway pressure in moderate to severe obstructive sleep apnea

et al. 2017

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“…Similar findings, albeit with slightly higher CPAP cutoff values, have also been reported in a predominantly Caucasian sample. 26 Conversely, other studies have demonstrated that therapeutic CPAP levels poorly predict oral appliance treatment response 27 and do not predict which individuals respond to nasal expiratory positive airway pressure therapy. 8 Given the complexity of OSA pathophysiology, it is likely that other physiological factors may be important in predicting the likelihood of therapeutic response.…”

Section: Discussionmentioning

confidence: 99%

Therapeutic CPAP Level Predicts Upper Airway Collapsibility in Patients With Obstructive Sleep Apnea

Landry

Joosten

Eckert

et al. 2017

Sleep

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Our data demonstrate that a patient's therapeutic CPAP requirement shares a strong predictive relationship with their Pcrit and may be used to accurately differentiate OSA patients with mild airway collapsibility from those with moderate-to-severe collapsibility. Although this relationship needs to be confirmed prospectively, our findings may provide clinicians with better understanding of an individual patient's OSA phenotype, which ultimately could assist in determining which patients are most likely to respond to non-CPAP therapies.

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