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Title: Therapeutic CPAP level predicts upper airway collapsibility in patients with obstructive sleep apnea
Austin Authors: Landry, Shane A;Joosten, Simon A;Eckert, Danny J;Jordan, Amy S ;Sands, Scott A;White, David P;Malhotra, Atul ;Wellman, Andrew ;Hamilton, Garun S;Edwards, Bradley A
Affiliation: Institute for Breathing and Sleep
Sleep and Circadian Medicine Laboratory, Department of Physiology, Monash University, Melbourne, Victoria, Australia
School of Psychological Sciences and Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Melbourne, Victoria, Australia
School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia
Monash Partners - Epworth, Melbourne, Australia
Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
Neuroscience Research Australia (NeuRA) and the University of New South Wales, Randwick, Sydney, New South Wales, Australia
Melbourne School of Psychological Sciences, University of Melbourne, Parkville, Victoria, Australia
Department of Allergy, Immunology and Respiratory Medicine and Central Clinical School, The Alfred and Monash University, Melbourne, Victoria, Australia
Division of Pulmonary and Critical Care Medicine, University of California San Diego, CA
Issue Date: 1-Jun-2017
Publication information: Sleep 2017; 40(6): zsx056
Abstract: STUDY OBJECTIVES: Upper airway collapsibility is a key determinant of obstructive sleep apnea (OSA) which can influence the efficacy of certain non-continuous positive airway pressure (CPAP) treatments for OSA. However, there is no simple way to measure this variable clinically. The present study aimed to develop a clinically implementable tool to evaluate the collapsibility of a patient's upper airway. METHODS: Collapsibility, as characterized by the passive pharyngeal critical closing pressure (Pcrit), was measured in 46 patients with OSA. Associations were investigated between Pcrit and data extracted from patient history and routine polysomnography, including CPAP titration. RESULTS: Therapeutic CPAP level, demonstrated the strongest relationship to Pcrit (r2=0.51, p < .001) of all the variables investigated including apnea-hypopnea index, body mass index, sex, and age. Patients with a mildly collapsible upper airway (Pcrit ≤ -2 cmH2O) had a lower therapeutic CPAP level (6.2 ± 0.6 vs. 10.3 ± 0.4 cmH2O, p < .001) compared to patients with more severe collapsibility (Pcrit > -2 cmH2O). A therapeutic CPAP level ≤8.0 cmH2O was sensitive (89%) and specific (84%) for detecting a mildly collapsible upper airway. When applied to the independent validation data set (n = 74), this threshold maintained high specificity (91%) but reduced sensitivity (75%). CONCLUSIONS: 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.
DOI: 10.1093/sleep/zsx056
Journal: Sleep
PubMed URL:
Type: Journal Article
Subjects: CPAP
Obstructive sleep apnea
Appears in Collections:Journal articles

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