Abstract
BackgroundPositive airway pressure is the main treatment modality in obstructive sleep apnea. The level of pressure needed for each patient is defined by a positive airway pressure titration study. Predicting those who need higher pressure or bi-level instead of continuous pressure is of a great clinical significance. This study was designed to evaluate whether voluntary breath-holding maneuver could predict Bilevel Positive Airway Pressure (BiPAP) or Continuous Positive Airway Pressure (CPAP) as the final optimal pressure in a split night study of patients with obstructive sleep apnea. Polysomnography (PSG) parameters specially oxygen saturation (SaO2) during non-rapid eye movement (NREM), rapid eye movement sleep (REM), and duration of REM in diagnostic part may help determine the type of devices as soon as possible in split night study.MethodsThe present research was conducted as a cross-sectional study of adults diagnosed as obstructive sleep apnea patients undergoing positive airway pressure (PAP) titration. Demographic, anthropometric, and polysomnographic data were collected. Patients were instructed to hold their breath as long as they could after five tidal breaths in the supine position. Baseline, post breath-holding phase, and recovery SaO2 were recorded. These data were used to predict the pressure level and type of device.ResultsSeventy-eight participants (56.4% male) with the mean age of 55.7 ± 13.9 years were included in the study. Mean and SD of apnea hypopnea index (AHI) and oxygen desaturation index (ODI) were 55.9 ± 34.4 and 38.3 ± 24 per hour, respectively. Most of the participants (65.3%) were categorized as CPAP group. CPAP and BiPAP groups were similar in terms of age, gender distribution, body mass index (BMI), neck circumference, and certain polysomnographic variables. Voluntary breath-holding maneuver showed a significant correlation between minimum SaO2 and the need for changing to BiPAP during titration. Baseline and post breath-holding SaO2 were not significantly lower in either group. NREM minimum SaO2 and REM duration were the statistically significant correlated variables that predicted the need for BiPAP.ConclusionMinimum oxygen following voluntary breath-holding maneuver along with higher BMI and larger neck circumference are predictors of the need to use BiPAP. Shorter REM duration and NREM minimum SaO2 were other predictors of higher chance of BiPAP during titration of the present OSA participants.
Highlights
Positive airway pressure is the main treatment modality in obstructive sleep apnea
rapid eye movement sleep (REM) Duration less than 12.1 min was considered as the root of the Decision Tree, meaning that REM duration more than 12.1 min showed a 100% probability of continuing Continuous Positive Airway Pressure (CPAP)
In those participants whose REM Duration is less than 12.1 min, minimum Oxygen Saturation (SaO2) during non-rapid eye movement (NREM) was the level node changing CPAP to Bilevel Positive Airway Pressure (BiPAP) (Fig. 2)
Summary
Positive airway pressure is the main treatment modality in obstructive sleep apnea. The level of pressure needed for each patient is defined by a positive airway pressure titration study Predicting those who need higher pressure or bi-level instead of continuous pressure is of a great clinical significance. This study was designed to evaluate whether voluntary breath-holding maneuver could predict Bilevel Positive Airway Pressure (BiPAP) or Continuous Positive Airway Pressure (CPAP) as the final optimal pressure in a split night study of patients with obstructive sleep apnea. Positive Airway Pressure (PAP) is the main therapeutic method for dealing with Obstructive Sleep Apnea (OSA). The patient would use the suitable device to optimally alleviate obstructive events (Antonescu-Turcu & Parthasarathy, 2010; Carlucci et al, 2015; Kushida et al, 2008).PAP titration process needs expertise and time; it is usually interrupted by multiple awakenings which can further delay the titration process or constrain a repeat titration study. Apnea Hypopnea Index, and neck circumference are considered to be the main predictive factors for the prediction of CPAP pressure in the body of related literature (Abdel Wahab & Ahmed, 2017; Camacho, Riaz, Tahoori, Certal, & Kushida, 2015; Ebben, Narizhnaya, & Krieger, 2017; Noseda et al, 2009)
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