Prediction of optimal continuous positive airway pressure in Thai patients with obstructive sleep apnea

Abstract

Continuous positive airway pressure (CPAP) is simple and effective treatment for obstructive sleep apnea (OSA) patients. However, the CPAP prediction equation in each country is different. This study aimed to predict CPAP in Thai patients with OSA. A retrospective study was conducted in Thai patients, who OSA was confirmed by polysomnography and CPAP titration from January 2015 to December 2018. Demographics, body mass index (BMI), neck circumference (NC), Epworth sleepiness scale, apnea–hypopnea index (AHI), respiratory disturbance index (RDI), mean and lowest pulse oxygen saturation (SpO2), and optimal pressure were recorded. A total of 180 subjects were included: 72.8% men, age 48.7 ± 12.7 years, BMI 31.0 ± 6.3 kg/m2, NC 40.7 ± 4.1 cm, AHI 42.5 ± 33.0 per hour, RDI 47.1 ± 32.8 per hour, and lowest SpO2 77.1 ± 11.0%. Multiple linear regression analysis identified NC, BMI, RDI, and lowest SpO2. A final CPAP predictive equation was: optimal CPAP (cmH2O) = 4.614 + (0.173 × NC) + (0.067 × BMI) + (0.030 × RDI) − (0.076 × lowest SpO2). This model accounted for 50.0% of the variance in the optimal pressure (R2 = 0.50). In conclusion, a CPAP prediction equation can be used to explain a moderate proportion of the titrated CPAP in Thai patients with OSA. However, the CPAP predictive equation in each country may be different due to differences of ethnicity and physiology.Trial registration: TCTR20200108003.

A predictive model for optimal continuous positive airway pressure in the treatment of pure moderate to severe obstructive sleep apnea in China

“…Our results declared that minSpO 2 was also an independent predictor for optimal value of CPAP. This was similar to several previous studies [16,23,24,29]. Oxyhemoglobin desaturation during sleep is directly related to the duration of apnea and indirectly to end-tidal lung volume at the beginning of apnea, without considering other causes such as lung diseases and/or hypoventilation.…”

“…They concluded that BMI were the most important independent predictors of optimal value of CPAP [22]. Extensive clinical researches have shown that BMI was one of the independent factors affecting the optimal CPAP [16,[23][24][25] (Table 4). AHI is the gold standard for the diagnosis and severity classification of OSA.…”

“…Laboratory-based manual titration was performed throughout the night to determine the optimal pressure for CPAP. Optimal pressure was defined as the lowest effective pressure that could control most respiratory disturbances, including apnea and hypopnea events and snoring in all body positions and stages, especially in the supine position during rapid-eye movement (REM) sleep [15].The specific manifestations were residual AHI < 5 events per hour, and supine REM at least 15 min after treatment [16].…”

Optimal positive airway pressure requirement and polysomnography indices of obstructive sleep apnea severity in the Saudi population

“…[ 26 ] Thereafter, several reports suggested similar results in Caucasian, Asian, and mixed populations. [ 17 37 38 39 40 41 ] In this study, the number of respiratory events per hour of NREM sleep was a predictor of the optimal PAP requirement when considered independently but not during multivariable analyses. Although the AHI has been used for decades to define OSA severity in research and clinical practice,[ 1 ] it captures a single aspect of OSA severity (i.e., the number of respiratory events) and ignores many other aspects (e.g., the length and type of events), which renders its reliability questionable.…”

“…In the current study, deoxygenation indices allowed a better prediction of the optimal PAP requirement when multiple variables were analyzed, and this was also noted in earlier reports. [ 40 41 47 48 49 ] The arousal index was selected for inclusion in our PAP prediction equation. We found no previous studies reporting the inclusion of indices of arousal disturbance during sleep in PAP prediction equations.…”