Does Patient’s Initial Evaluation Predict a Change in Optimal Pressure on CPAP Retitration?

Narayan P. Verma

OUWB School of Medicine and B. G. Tri-county Neurology and Sleep Clinic, Warren, MI, USA.

DOI: 10.4236/ijcm.2014.54023                

Abstract

Introduction: Only vindication of a nasal continuous positive airway pressure (CPAP) retitration procedure will be an actual change in the optimal CPAP pressure after that test. The purpose of this study was to identify any items in patient characteristics, clinical features, baseline PSG and initial CPAP titration as predictors of change in optimal pressure on CPAP retitration. Methods: 46 patients with obstructive sleep apnea (OSA) were divided in two groups: Group I (optimal pressure was changed on CPAP retitration): N = 30, M 22 and F 8, age 31-72, BMI 26-50 Kg/m², neck size 15 – 20", tonsillectomy in 8, narrow oropharynx in 15, uvuvlopalatopharyngoplasty (UP3) in 2, abnormal chin in 3, deviated nasal septum (DNS) and prior nose surgery in 1 each, initial CPAP pressure 6-19 cm, sleep efficiency 65%-98%, REM latency 0-304 minutes and residual apnea hypopnea index (AHI) 0-23/hour. Group II (optimal pressure unchanged after CPAP retitration): N = 16, M 11 and 5 F, age 32-69, BMI 23-62 Kg/m², neck size 14.5-20", tonsillectomy in 6, narrow oropharynx in 5, abnormal chin in 4, corrective nasal surgery in 2, DNS in 1, initial CPAP pressure 8-13 cm of H2O, sleep efficiency 69%-95%, REM latency 0-270 minutes and residual AHI 0-19/hour. The statistical analyses were performed using two-tailed Fisher’s t test and unpaired t test. A p value of <0.05 was considered statistically significant. Results: Patient characteristics (age, gender, neck size, and BMI), clinical features (tonsillar status, oropharyngeal narrowing, chin abnormality, DNS/nasal surgery or UP3), baseline PSG or initial CPAP titration (sleep efficiency, REM latency, residual AHI and initial CPAP pressure) did not differ significantly between the 2 groups (p = 0.09-0.99). Conclusion: Patient characteristics, clinical features or variables on baseline PSG and initial CPAP titration do not predict a change in optimal pressure on CPAP retitration. The results suggest that 1) Significant weight change; 2) Patient’s subjective feeling of pressure being too high or insufficient; 3) Residual or recurrent daytime sleepiness uncorrected by interface readjustments; 4) Post-op

Keywords

Obstructive Sleep Apnea; CPAP Titration; CPAP Retitration

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	N. J. Ali, D. J. Pitson and J. R. Strading, “Snoring, Sleep Disturbance and Behaviour in 4 to 5 Years Olds,” Archives of Disease in Childhood, Vol. 68, No. 3, 1993, pp. 360-366. http://dx.doi.org/10.1136/adc.68.3.360
[2]	T. Gislason and Benediktsdottir, “Snoring, Apneic Episodes and Nocturnal Hypoxemia among Children 6 Months to 6 Years Old,” Chest, Vol. 107, No. 4, 1995, pp. 963-966. http://dx.doi.org/10.1378/chest.107.4.963
[3]	T. Young, M. Palta, J. Dempsey, J. Skatrud, S. Weber and S. Badr, “The Occurrence of Sleep-Disordered Breathing among Middle Aged Adults,” The New England Journal of Medicine, Vol. 328, No. 17, 1993, pp. 1230-1235. http://dx.doi.org/10.1056/NEJM199304293281704
[4]	ATS Statement, “Indications and Standards of Use of Nasal Continuous Positive Airway Pressure (CPAP) in Sleep Apnea Syndromes,” American Journal of Respiratory and Critical Care Medicine, Vol. 150, No. 6, 1994, pp. 1738-1745.
[5]	D. I. Loube, P. C. Gay, K. P. Strohl, A. I. Pack, D. P. White and N. A. Collop, “Indications for Positive Airway Pressure Treatment for Adult Obstructive Sleep Apnea Patients: A Consensus Statement,” Chest, Vol. 115, No. 3, 1999, pp. 863-866. http://dx.doi.org/10.1378/chest.115.3.863
[6]	P. Lloberes, S. Marti, G. Sampol, A. Roca, T. Sagales, X. Munoz and M. Ferrer, “Predictive Factors of Quality of Life Improvement and Continuous Positive Airway Pressure Use in Patients with Sleep Apnea-Hypopnea Syndrome: Study at 1 Year,” Chest, Vol. 126, No. 4, 2004, pp. 1241-1247. http://dx.doi.org/10.1378/chest.126.4.1241
[7]	R. J. Schwab, A. I. Pack, K. B. Gupta, L. J. Metzger, E. Oh, J. E. Getsy, E. A. Hoffman and W. B. Gefter, “Upper Airway and Soft Tissue Structural Changes Induced by CPAP in Normal Subjects,” American Journal of Respiratory and Critical Care Medicine, Vol. 154, No. 4, 1996, pp. 1106-1116. http://dx.doi.org/10.1164/ajrccm.154.4.8887615
[8]	N. C. Abbey, A. J. Block, D. Green, A. Mancuso and D. W. Hellard, “Measurement of Pharyngeal Volume by Digitized Magnetic Resonance Imaging: Effect of Nasal Continous Positive Airway Pressure,” American Review of Respiratory Disease, Vol. 140, No. 3, 1989, pp. 717-723. http://dx.doi.org/10.1164/ajrccm/140.3.717
[9]	M. G. Stewart, D. G. Glaze, E. M. Friedman, E. O. Smith and M. Bautista, “Quality of Life and Sleep Study Findings after Adenotonsillectomy in Children with Obstructive Sleep Apnea,” JAMA Otolaryngology—Head & Neck Surgery, Vol. 131, No. 4, 2005, pp. 308-314. http://dx.doi.org/10.1001/archotol.131.4.308
[10]	F. Larrosa, L. Hernandez, A. Morello, E. Ballester, L. Quinto and J. M. Montserrat, “Laser Assisted Uvulopalatoplasty for Snoring: Does It Meet the Expectations?” European Respiratory Journal, Vol. 24, No. 1, 2004, pp. 66-70. http://dx.doi.org/10.1183/09031936.04.00082903
[11]	H. Buchwald, Y. Avidor, E. Braunwald, M. D. Jensen, W. Pories, K. Fahrbach, et al., “Bariatric Surgery: A Systematic Review and Meta-Analysis,” JAMA, Vol. 292, No. 14, 2004, pp. 1724-1737. http://dx.doi.org/10.1001/jama.292.14.1724
[12]	C. W. Zwillich, C. Pickett, F. N. Hanson and J. V. Weil “Disturbed Sleep and Prolonged Apnea during Nasal Obstruction in Normal Men,” American Review of Respiratory Disease, Vol. 124, No. 2, 1981, pp. 158-160.
[13]	R. C. Heinzer, M. L. Stanchina, A. Malhotra, R. B. Fogel, S. R. Patel, A. S. Jordan, K. Schory and D. P. White, “Lung Volume and Continous Positive Airway Pressure Requirements in Obstructive Sleep Apnea,” American Journal of Respiratory and Critical Care Medicine, Vol. 172, No. 1, 2005, p. 114. http://dx.doi.org/10.1164/rccm.200404-552OC
[14]	A. L. Chesson Jr., R. A. Ferber, J. M. Fry, et al., “Practice Parameters for the Indications for Polysomnography and Related Procedures,” Sleep, Vol. 20, No. 6, 1997, pp. 406-422.
[15]	A. Rechtschaffen and A. Kales, “Manual of Standardized Terminology: Technique and Scoring System for Sleep Stages of Human Subjects,” UCLA Brain Information Service/Brain Research Institute, Los Angeles, 1968.