Predicting nasal continuous positive airway pressure.

Hoffstein, V.; Mateika, Susan

doi:10.1164/ajrccm.150.2.8049834

Cited by 82 publications

(58 citation statements)

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“…BMI and neck circumference also relate to CPAP pressure in Caucasian populations. 17,18 Craniofacial measurements have additionally contributed to CPAP pressure determination in a Japanese study, whereas only soft palate length had any association with CPAP pressure in a French study. 19,20 Therefore craniofacial/obesity factors may have also differentially contributed to MAS response and/or CPAP pressure requirements between the two populations, although craniofacial factors were not assessed in either study.…”

Section: Discussionmentioning

confidence: 97%

CPAP Pressure for Prediction of Oral Appliance Treatment Response in Obstructive Sleep Apnea

Sutherland

Phillips

Davies

et al. 2014

Journal of Clinical Sleep Medicine

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Study Objectives: Mandibular advancement splints (MAS) are often preferred to CPAP treatment for OSA but are not always equally effi cacious. High therapeutic CPAP pressure has been associated with MAS treatment failure in a Japanese population. We sought to assess the relationship between CPAP pressure and MAS treatment response in an Australian population. Methods: Therapeutic CPAP pressure and MAS treatment response were obtained from a one-month crossover trial of both treatments. Predictive utility of CPAP pressure to identify MAS treatment response was assessed. Results: Seventy-eight OSA patients were included (age 49.3 ± 11.1 years, BMI 29.1 ± 5.8 kg/m 2 ) with predominantly moderate-severe OSA (AHI 30.0 ± 12.7/h). CPAP pressure was lower in MAS responders (MAS AHI < 10/h) 9.7 ± 1.6 vs. 11.7 ± 2.4 cm H 2 O, p < 0.01, with area under ROC curve of 0.74 (95% CI 0.63-0.86), p < 0.01. The best cutoff value of 10.5 cm H 2 O useful for discriminating MAS responders and non-responders in the previous Japanese population, was inadequate for prediction in the current population (0.47 negative predictive value [NPV] S C I E N T I F I C I N V E S T I G A T I O N SC ontinuous positive airway pressure (CPAP) is the standard treatment for obstructive sleep apnea (OSA). Although highly effi cacious, CPAP is often hindered by poor tolerance and suboptimal adherence, 1 limiting its effectiveness in the real world. Mandibular advancement splints (MAS) are an alternative option recommended as a fi rst-line treatment for mildmoderate OSA. 2 We have recently found that health outcome improvements, including sleepiness, are similar with MAS and CPAP treatments in patients with moderate-severe OSA. Superior patient adherence appears to offset any inferiority of MAS effi cacy, 3 and MAS may be considered a viable alternative for many patients.However despite similar health benefi ts between treatments, approximately one-third of OSA patients will not respond to MAS. [4][5][6][7] This is of signifi cant concern in terms of resource wastage and treatment delays. Much attention has been given to understanding patient phenotypes which relate to MAS response such as gender, obesity, craniofacial structure, and type and severity of OSA.8 However, none of these factors are universal, and hence there is an unresolved need for reliable indicators of MAS treatment response. A recent Japanese study has identifi ed pressure requirement in CPAP users as a predictor of MAS response. 9 In established CPAP users, a prescribed pressure of above 10.5 cm H 2 O indicated poor response to subsequent MAS therapy. This prediction method is, of course, restricted to patients who have used CPAP and wish to try MAS. However CPAP pressure would represent a simple predictor, either alone or possibly in combination with other patient characteristics to further improve BRIEF SUMMARY Current Knowledge/Study Rationale: CPAP pressure has been shown to predict oral appliance treatment response in Japanese male OSA patients and could be a simple and useful clini...

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Section: Discussionmentioning

confidence: 97%

CPAP Pressure for Prediction of Oral Appliance Treatment Response in Obstructive Sleep Apnea

Sutherland

Phillips

Davies

et al. 2014

Journal of Clinical Sleep Medicine

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“…HOFFSTEIN and MATEIKA [19] proposed an equation to predict the optimal level of CPAP that prevents sleep apnoea by using parameters such as BMI, neck circumference, and apnoea/ hypopnoea index, which induced a reduction in apnoea/ hypopnoea index below 10 events·h -1 . However, there was no information concerning the efficiency with which this estimated pressure would suppress snoring, and the evolution of daytime vigilance was not considered.…”

Section: Discussionmentioning

confidence: 99%

Influence of correction of flow limitation on continuous positive airway pressure efficiency in sleep apnoea/hypopnoea syndrome

Meurice

Paquereau²,

Denjean³

et al. 1998

Eur Respir J

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aaSleep apnoea/hypopnoea syndrome (SAHS) is an important public health problem leading to increases in mortality [1], the related morbidity rate of cardiovascular and cerebrovascular diseases [2], and neuropsychological dysfunctions [3,4]. These increases in risk factors emphasize the need for an effective treatment in SAHS. The first description of the beneficial effects of nasal continuous positive airway pressure (CPAP) in the treatment of SAHS was reported by SULLIVAN et al. in 1981 [5], and its effectiveness is demonstrated by dramatic improvements in morbidity and mortality with CPAP therapy [6][7][8][9].The level of the effective positive pressure (Peff) has been determined according to several different methods. Usually, Peff level is identified during a titration sleep study and corresponds to the minimal pressure level that prevents apnoea, hypopnoea and snoring in all sleep stages and body positions. In the absence of CPAP-related side effects, such as nasal obstruction, and poor CPAP observance, the persistence of excessive daytime sleepiness during the course of CPAP therapy has led to the hypothesis that sleep could be disturbed by persisting upper airway abnormalities inducing increased respiratory efforts associated with persisting sleep fragmentation due to recurrent arousals. This pointed out the need to increase Peff to the level that minimizes respiratory efforts in order to restore upper airway patency [10]. Such a pressure level should, therefore, suppress inspiratory flow limitation as assessed by the disappearance of inspiratory plateauing of the flow signal recorded with a pneumotachograph [11]. However, the clinical benefits of correcting flow limitation compared to the suppression of apnoea, hypopnoea and snoring during CPAP therapy in SAHS have never been evaluated.Therefore, the aim of the present study was to make a prospective comparison of the efficiency of two different settings of CPAP therapy in the treatment of SAHS: the first mode corresponding to the pressure level that suppressed snoring, apnoea and hypopnoea, while the second mode corresponded to the positive pressure level that normalized these events and abolished flow limitation. Materials and methods PatientsTwenty three untreated male SAHS patients initially accepted the invitation to participate in this study. However, we failed to obtain complete results in five patients. These results tend to show that correcting flow limitation is associated with a higher observance and a more important efficiency in normalizing daytime vigilance than with conventional nasal continuous positive airway pressure.

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“…Until recently, CPAP titration was always carried out in the sleep laboratory, but this is a costly and labour-intensive procedure. Many strategies have been attempted to reduce this expense, including prediction formulae [5,6], split night studies [7], attended home titration, partner titration and home stepwise titration. An alternative is to automate the titration process and determine a single pressure suitable for subsequent at-home fixed pressure treatment.…”

Section: P Lévy J-l Pepinmentioning

confidence: 99%