Influence of apnea vs hypopnea predominance in predicting mean therapeutic positive airway pressures among patients with obstructive sleep apnea

Yu, Jason L.; Liu, Yifan; Tangutur, Akshay; Arnold, Monique; Seay, Everett G; Schwartz, Alan R.; Dedhia, Raj C.

doi:10.5664/jcsm.9342

Cited by 9 publications

(16 citation statements)

References 33 publications

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“…Some studies also focused on the clinical differences between apnea- and hypopnea-dominant OSA patients. Apnea-predominant patients had more severe OSA disease ( 46 ) and slightly higher PAP levels ( 47 ) than hypopnea-predominant patients. The more intensive desaturation resulting from apnea rather than hypopnea may play a critical role in insulin resistance and hyperglycemia.…”

Section: Discussionmentioning

confidence: 97%

Shorter respiratory event duration is related to prevalence of type 2 diabetes

Guo

Dai²,

Luo³

et al. 2023

Front. Endocrinol.

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BackgroundObstructive sleep apnea (OSA) is a heterogeneous sleep disorder often comorbid with metabolic diseases, and type 2 diabetes (T2DM) is one of them. Although apnea hypopnea index (AHI) is currently the diagnostic criteria for OSA severity, a controversial relationship between AHI and T2DM has been found. On the other hand, the duration of apnea–hypopnea events has been shown to be a useful metric for predicting mortality. This study aimed to test whether average respiratory event duration was associated with prevalence of T2DM.MethodsPatients referred to the sleep clinic were recruited in the study. Baseline clinical characteristics and polysomnography parameters including average respiratory event duration were collected. The association of average respiratory event duration with the prevalence of T2DM was evaluated by univariate and multivariate logistic regression analyses.ResultsA total of 260 participants were enrolled, and 92 (35.4%) had T2DM. Univariate analysis revealed that age, body mass index (BMI), total sleep time, sleep efficiency, history of hypertension, and shorter average respiratory event duration were associated with T2DM. In multivariate analysis, only age and BMI remained significant. While average respiratory event duration was insignificant in multivariate analysis, subtype event analysis showed that shorter average apnea duration was both significant in univariate (OR, 0.95; 95% CI, 0.92–0.98) and multivariate analyses (OR, 0.95; 95% CI, 0.91–0.99). Neither average hypopnea duration nor AHI was associated with T2DM. Significant association (OR, 1.19; 95% CI, 1.12–1.25) was observed between shorter average apnea duration and lower respiratory arousal threshold after multivariate adjustment. However, causal mediation analysis revealed no mediating effect of arousal threshold on average apnea duration and T2DM.ConclusionThe average apnea duration may be a useful metric in the diagnosis of OSA comorbidity. Shorter average apnea duration indicating poor sleep quality and augmented autonomic nervous system responses might be the potential pathological mechanisms leading to T2DM.

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Section: Discussionmentioning

confidence: 97%

Shorter respiratory event duration is related to prevalence of type 2 diabetes

Guo

Dai²,

Luo³

et al. 2023

Front. Endocrinol.

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“…Whether hypopnea or apnea predominance affects treatment outcomes in patients with OSA is a topic of interest. A recent study showed a clinically insignificant difference in therapeutic positive airway pressure levels between hypopnea‐ and apnea‐predominant groups, suggesting that apnea percentage may not affect treatment outcomes 20 . However, the surgical response has not been directly compared between the two groups.…”

Section: Discussionmentioning

confidence: 99%

“…A recent study showed a clinically insignificant difference in therapeutic positive airway pressure levels between hypopnea-and apneapredominant groups, suggesting that apnea percentage may not affect treatment outcomes. 20 However, the surgical response has not been directly compared between the two groups. In the current study, we observed that both groups showed a substantial improvement in various PSG parameters.…”

Section: Postoperative Complicationsmentioning

confidence: 99%

Comparison of clinical features and surgical outcomes between hypopnea‐ and apnea‐predominant obstructive sleep apnea

Rha

Jeong

Al-Yahya

et al. 2022

Clinical Otolaryngology

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Objectives This study is aimed to investigate the differences in the clinical features and surgical outcomes between hypopnea‐ and apnea‐predominant obstructive sleep apnea (OSA). Design Cohort study. Setting Single tertiary care centre. Participants This study included 190 patients with OSA who underwent multilevel upper airway surgery between September 2012 and September 2021. The patients were divided into two groups according to the proportion of each respiratory event: hypopnea‐predominant (n = 102) and apnea‐predominant (n = 88). Main Outcome Measures The primary outcome measure was the percentage improvement in the apnea‐hypopnea index (AHI) from baseline AHI after surgery. Results The apnea‐predominant group included more male patients and had higher AHI, respiratory disturbance index (RDI) and oxygen desaturation index (ODI) than the hypopnea‐predominant group. Both groups showed significant improvements in AHI, apnea index, RDI, supine AHI, REM AHI, non‐REM AHI, ODI, lowest O2 saturation and Epworth Sleepiness Scale scores following the surgery. Notably, hypopnea index increased after surgery in the apnea‐predominant OSA group. Although the improvement in the absolute value of AHI by surgery was significantly greater in the apnea‐predominant group than in the hypopnea‐predominant group, the two groups showed no significant difference in the percentage improvement in AHI from baseline AHI. Conclusion Patients with apnea‐predominant OSA had more severe disease than those with hypopnea‐predominant OSA; however, surgical outcomes, as evaluated by percentage AHI improvement, were comparable between the two groups. In addition, multilevel upper airway surgery may induce the transition from apnea to hypopnea in patients with apnea‐predominant OSA.

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“…Thus, understanding collapsibility measures obtained during DISE and their relationships to known risk factors and clinical manifestations of OSA is paramount. Previous data have shown therapeutic PAP level to predict airway collapsibility and therapeutic PAP level to associate with AHI 11,33 . As collapsibility can be quantified with DISE‐PAP, there is a need to understand how its values associate with other disease features of OSA.…”

Section: Introductionmentioning

confidence: 99%

Airway Collapsibility during Drug‐Induced Sleep Endoscopy Relates with Clinical Features of Obstructive Sleep Apnea

Parekh,

Triantafillou,

Keenan

et al. 2023

The Laryngoscope

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IntroductionIncreased pharyngeal collapsibility leads to obstructive sleep apnea (OSA). Positive airway pressure titration during drug‐induced sleep endoscopy (DISE‐PAP) provides objective collapsibility metrics, the pharyngeal opening pressure (PhOP), and active pharyngeal critical pressure (PcritA). We examined the interrelationships between risk factors of OSA, airway collapsibility measures, and clinical manifestations of the disease.MethodsThis is a cross‐sectional analysis of consecutive OSA patients undergoing DISE‐PAP. Nasal PAP was increased stepwise until inspiratory flow limitation was abolished, signifying PhOP. PcritA was derived from the resulting titration pressure‐flow relationships. Clinical data including demographics, anthropometrics, sleep studies, and patient‐symptom questionnaires were obtained from the electronic medical record. Multivariate regression was used to evaluate the relationship between risk factors, airway collapsibility, and clinical data.ResultsOn average, the 164 patients meeting inclusion criteria were middle‐aged (54.2 ± 14.7 years), overweight/obese (BMI 29.9 ± 4.5 kg/m2), male (72.6%), White (79.3%) and had severe OSA (AHI 32.0 ± 20.5 events/hour). Mean PhOP was 7.5 ± 3.3 cm H2O and mean PcritA was 0.80 ± 3.70 cm H2O. Younger age (Standardized β = −0.191, p = 0.015) and higher BMI (Standardized β = 0.176, p = 0.028) were associated with higher PhOP, but not PcritA. PhOP and PcritA were both associated with AHI, supine AHI, and SpO2 nadir. Higher PhOP was associated with higher snoring scores (Standardized β = 0.246, p = 0.008), but not other patient‐reported outcomes.ConclusionObjective assessment of passive and active airway mechanics during DISE relates with clinical risk factors for OSA. Quantitative measures of collapsibility provide accessible and meaningful data, enhancing the standard sleep surgery evaluation.Level of Evidence4 Laryngoscope, 2023

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Influence of apnea vs hypopnea predominance in predicting mean therapeutic positive airway pressures among patients with obstructive sleep apnea

Cited by 9 publications

References 33 publications

Shorter respiratory event duration is related to prevalence of type 2 diabetes

Shorter respiratory event duration is related to prevalence of type 2 diabetes

Comparison of clinical features and surgical outcomes between hypopnea‐ and apnea‐predominant obstructive sleep apnea

Airway Collapsibility during Drug‐Induced Sleep Endoscopy Relates with Clinical Features of Obstructive Sleep Apnea

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