Therapeutic CPAP level predicts upper airway collapsibility in patients with obstructive sleep apnea: Therapeutic CPAP predicts upper airway collapsibility

AuthorsLandry, S.A.
Joosten, S.A.
Eckert, D.J.
Jordan, A.S.
Sands. S.A.
White, D.P.
Malhotra, A.
Wellman, A.
Hamilton, G.S.
Edwards, B.A.
TypeJournal Article (Original Research)
PubMed ID28419320
Year of Publication2017
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AbstractStudy Objectives: Upper airway collapsibility is a key determinant of obstructive sleep apnea (OSA) which can influence the efficacy of certain non-CPAP treatment 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<0.001) of all of the variables investigated including AHI, BMI, sex and age. Patients with a mildly collapsible upper airway (Pcrit</=-2cmH2O) had a lower therapeutic CPAP level (6.2+/-0.6 vs. 10.3+/-0.4cmH2O, p<0.001) compared to patients with more severe collapsibility (Pcrit>-2cmH2O). A therapeutic CPAP level</=8.0cmH2O was sensitive (89%) and specific (84%) for detecting a mildly collapsible upper airway. When applied to the independent validation dataset (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.

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