New Predictive Equation for Optimal Continuous Positive Airway Pressure in Adult Patients with Obstructive Sleep Apnea

Authors

  • Kanokkan Pengsakul Songklanagarind Sleep Center, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand.
  • Krongthong Tawaranurak Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand.
  • Chuanchom Bumrungsena Nursing Department, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand.
  • Chitladda Chaimongkol Nursing Department, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand.
  • Jarurin Pitanupong Department of Psychiatry, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand.

DOI:

https://doi.org/10.31584/jhsmr.2021834

Keywords:

continuous positive airway pressure, obstructive sleep apnea, optimal pressure, predictive equation, sleep apnea

Abstract

Objective: This study aimed to develop and validate a new continuous positive airway pressure (CPAP) prediction equation and compare it with other formulas.

Material and Methods: We retrospectively included patients with obstructive sleep apnea who underwent a CPAP titration study between January 2012 and December 2016. All clinical and polysomnographic data were collected. The new prediction equation was developed using the first data set, and the predictability performance was validated using the second data set.

Results: Among the 266 enrolled patients, 73.7% were male, and the mean body mass index (BMI) was 30.8 7.4 kg/m2. Five variables, namely age, BMI, neck circumference (NC), apnea–hypopnea index (AHI), and minimum pulse oxygen saturation (Min SpO2), highly correlated with the optimal titration pressure, and were therefore included in the equation, as stated below:

Predicted pressure (cm H2O) = 2.26 + (0.02xAge) + (0.04xBMI) + (0.11xNC) + (0.04xAHI) - (0.04xMin SpO2)

This equation accounted for 54.4% of the variance in predicting the optimal titration pressure (R2=0.544, p-value<0.001). Its optimal estimation was 62.0% in the validated group. The equation-derived predicted pressure correlated with good agreement with the laboratory-derived optimal titration pressure (r=0.70, 95% CI=0.6335–0.755, p-value<0.001) according to Bland–Altman analysis.

Conclusion: Our equation is highly consistent with the CPAP titration study in predicting fixed CPAP pressure, and is thereby beneficial for sleep technicians in establishing a starting pressure for such studies at a sleep laboratory.

Downloads

Download data is not yet available.

References

Peppard PE, Young T, Barnet JH, Palta M, Hagen EW, Hla KM. Increased prevalence of sleep-disordered breathing in adults. Am J Epidemiol 2013;177:1006-14.

Epstein LJ, Kristo D, Strollo PJ, Friedman N, Malhotra A, Patil SP, et al. Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med 2009;5:263-76.

Somers VK, White DP, Amin R, Abraham WT, Costa F, Culebras A, et al. Sleep apnea and cardiovascular disease: an American Heart Association/American College of Cardiology Foundation Scientific Statement from the American Heart Association Council for High Blood Pressure Research Professional Education Committee, Council on Clinical Cardiology, Stroke Council, and Council on Cardiovascular Nursing (2008). J Am Coll Cardiol 2008;52:686-717.

Kushida CA, Littner MR, Hirshkowitz M, Morgenthaler TI, Alessi CA, Bailey D, et al. Practice parameters for the use of continuous and bilevel positive airway pressure devices to treat adult patients with sleep-related breathing disorders. Sleep 2006; 29:375-80.

Kushida CA, Littner MR, Morgenthaler T, Alessi CA, Bailey D, Coleman J, et al. Practice parameters for the indications for polysomnography and related procedures: an update for 2005. Sleep 2005;28:499-521.

Morgenthaler TI, Aurora RN, Brown T, Zak R, Alessi C, Boehlecke B, et al. Practice parameters for the use of autotitrating continuous positive airway pressure devices for titrating pressures and treating adult patients with obstructive sleep apnea syndrome: an update for 2007. An American Academy of Sleep Medicine report. Sleep 2008;31:141-7.

Miljeteig H, Hoffstein V. Determinants of continuous positive airway pressure level for treatment of obstructive sleep apnea. Am Rev Respir Dis 1993;147:1526-30.

Oliver Z, Hoffstein V. Predicting effective continuous positive airway pressure. Chest 2000;117:1061-4.

Lin IF, Chuang ML, Liao YF, Chen NH, Li HY. Predicting effective continuous positive airway pressure in Taiwanese patients with obstructive sleep apnea syndrome. J Formos Med Assoc 2003;102:215-21.

Luo J, Xiao S, Qiu Z, Song N, Luo Y. Comparison of manual versus automatic continuous positive airway pressure titration and the development of a predictive equation for therapeutic continuous positive airway pressure in Chinese patients with obstructive sleep apnoea. Respirology 2013;18:528-33.

Lee GH, Kim MJ, Lee EM, Kim CS, Lee SA. Prediction of optimal CPAP pressure and validation of an equation for Asian patients with obstructive sleep apnea. Respir Care 2013;58:810-5.

Wu MF, Hsu JY, Huang WC, Shen GH, Wang JM, Wen CY, et al. Should sleep laboratories have their own predictive formulas for continuous positive airway pressure for patients with obstructive sleep apnea syndrome? J Chin Med Assoc 2014;77:283-9.

Lai CC, Friedman M, Lin HC, Wang PC, Hwang MS, Hsu CM, et al. Clinical predictors of effective continuous positive airway pressure in patients with obstructive sleep apnea/ hypopnea syndrome. Laryngoscope 2015;125:1983-7.

Johns MW. A new method for measuring daytime sleepiness: the Epworth Sleepiness Scale. Sleep 1991;14:540-5.

Banhiran W, Assanasen P, Nopmaneejumruslers C, Metheetrairut C. Epworth Sleepiness Scale in obstructive sleep disordered breathing: the reliability and validity of the Thai version. Sleep Breath 2011;15:571-7.

Friedman M, Ibrahim H, Bass L. Clinical staging for sleepdisordered breathing. Otolaryngol Head Neck Surg 2002; 127:13-21.

Friedman M, Salapatas AM, Bonzelaar LB. Updated Friedman staging system for obstructive sleep apnea. Adv Otorhinolaryngol 2017;80:41-8.

Berry RB, Brooks R, Gamaldo C, Harding SM, Lloyd RM, Quan SF, et al. AASM scoring manual updates for 2017 (Version 2.4). J Clin Sleep Med 2017;13:665-6.

Kapur VK, Auckley DH, Chowdhuri S, Kuhlmann DC, Mehra R, Ramar K, et al. Clinical practice guideline for diagnostic testing for adult obstructive sleep apnea: an American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med 2017;13:479-504.

Kushida CA, Chediak A, Berry RB, Brown LK, Gozal D, Iber C, et al. Positive Airway Pressure Titration Task Force of the American Academy of Sleep Medicine Clinical guidelines for the manual titration of positive airway pressure in patients with obstructive sleep apnea. J Clin Sleep Med 2008;4:157-71.

Kırgezen T, Bilici S, akır M, Ceyran , Chasan M, Yiğit . Factors affecting optimal titration pressure of continuous positive airway pressure device in patients with obstructive sleep apnea syndrome. Turk Arch Otorhinolaryngol 2020;58: 80-6.

McArdle N, Grove A, Devereux G, Mackay-Brown L, Mackay T, Douglas NJ. Split-night versus full-night studies for sleep apnoea/hypopnoea syndrome. Eur Respir J 2000;15:670-5.

BaHammam AS, ALAnbay E, Alrajhi N, Olaish AH. The success rate of split-night polysomnography and its impact on continuous positive airway pressure compliance. Ann Thorac Med 2015;10:274-8.

Farghaly S, Shaaban LH. Efficacy of split night CPAP titration in moderate and severe obstructive sleep apnea syndrome patients. Egypt J Chest Dis Tuberc 2016;65:251-7.

Callahan CY, Norman RG, Taxin Z, Mooney AM, Rapoport DM, Ayappa I. Multinight recording and analysis of continuous positive airway pressure airflow in the home for titration and management of sleep disordered breathing. Sleep 2013;36: 535-5F.

Marrone O, Salvaggio A, Romano S, Insalaco G. Automatic titration and calculation by predictive equations for the determination of therapeutic continuous positive airway pressure for obstructive sleep apnea. Chest 2008;133:670-6.

Farr R, Gozal D, Montserrat JM. Alternative procedure to individual nasal pressure titration for sleep apnea. J Clin Med 2021;10:1453.

Masa JF, Jim nez A, Dur n J, Capote F, Monasterio C, Mayos M, et al. Alternative methods of titrating continuous positive airway pressure: a large multicenter study. Am J Respir Crit Care Med 2004;170:1218-24.

West SD, Jones DR, Stradling JR. Comparison of three ways to determine and deliver pressure during nasal CPAP therapy for obstructive sleep apnoea. Thorax 2006;61:226-31.

Patil SP, Ayappa IA, Caples SM, Kimoff RJ, Patel SR, Harrod CG. Treatment of adult obstructive sleep apnea with positive airway pressure: an American academy of sleep medicine systematic review, meta-analysis, and GRADE assessment. J Clin Sleep Med 2019;15:301-34.

Downloads

Published

2021-09-01

How to Cite

1.
Pengsakul K, Tawaranurak K, Bumrungsena C, Chaimongkol C, Pitanupong J. New Predictive Equation for Optimal Continuous Positive Airway Pressure in Adult Patients with Obstructive Sleep Apnea. J Health Sci Med Res [Internet]. 2021 Sep. 1 [cited 2022 Jun. 26];40(3):271-9. Available from: https://he01.tci-thaijo.org/index.php/jhsmr/article/view/255387

Issue

Section

Original Article