Using Prediction Formulas for Continuous Positive Airway Pressure in Obstructive Sleep Apnea Syndrome
Background and Objective: Continuous positive airway pressure (CPAP) is a standard therapy for patients with moderate to severe obstructive sleep apnea (OSA). Increased demands for polysomnography (PSG) and CPAP titration have led to long waiting lists and high cost. CPAP prediction formulas derived from sleep and anthropometric parameters are used to set the initial CPAP level during CPAP titration. In the current study, we aimed to compare the pressure derived from prediction formulas with the pressure resulted from CPAP titration in a sample of Iranian patients.
Materials and Methods: In this cross-sectional study, 90 subjects with confirmed OSA in a full PSG who underwent CPAP titration in Baharloo Sleep Clinic, Tehran, Iran, during 2017, were enrolled. All of the participants had Respiratory Disturbance Index (RDI) ≥ 15 in their PSG test. Then, the optimal pressure obtained from manual CPAP titration was compared with the one calculated by different prediction formulas for each patient.
Results: The mean CPAP pressure from manual titration was greater than the pressures calculated by four prediction formulas. The difference between mean CPAP pressure obtained by manual titration and pressures calculated by Hoffstein, Lin, and Hukins formulas was statistically significant, whereas mean CPAP pressure obtained by manual titration was not statistically different from Loredo formula (11.7 ± 2.6 vs. 11.0 ± 2.3, P = 0.110).
Conclusion: Estimation of optimal therapeutic pressure for CPAP device using several prediction formulas is very similar to pressure found during manual titration study. These formulas can be used in our setting for estimation of optimal CPAP pressure to save time and cost.
2. Wilsmore BR, Grunstein RR, Fransen M, et al. Sleep habits, insomnia, and daytime sleepiness in a large and healthy community-based sample of New Zealanders. J Clin Sleep Med 2013; 9: 559-66.
3. O'Connor GT, Lind BK, Lee ET, et al. Variation in symptoms of sleep-disordered breathing with race and ethnicity: The Sleep Heart Health Study. Sleep 2003; 26: 74-9.
4. Young T, Palta M, Dempsey J, et al. The occurrence of sleep-disordered breathing among middleaged adults. N Engl J Med 1993; 328: 1230-5.
5. Arnold J, Sunilkumar M, Krishna V, et al. Obstructive sleep apnea. J Pharm Bioallied Sci 2017; 9: S26-S28.
6. Goodday RH. Nasal respiration, nasal airway resistance, and obstructive sleep apnea syndrome. Oral Maxillofac Surg Clin North Am 1997; 9:167–77.
7. Sullivan CE, Issa FG, Berthon-Jones M, et al. Reversal of obstructive sleep apnoea by continuous positive airway pressure applied through the nares. Lancet 1981; 1: 862-5.
8. Wu MF, Hsu JY, Huang WC, 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.
9. Franklin K, Lundgren R, Dahlqvist A, et al. Nasal CPAP--treatment of choice in obstructive sleep apnea. Nord Med 1992; 107: 42-5. [In Swedish].
10. Wright J, Johns R, Watt I, et al. Health effects of obstructive sleep apnoea and the effectiveness of continuous positive airways pressure: A systematic review of the research evidence. BMJ 1997; 314: 851-60.
11. Yu CC, Hua CC, Tseng JC, et al. Comparison optimal pressure between automatic titrating and predicting continuous positive airway pressure. Chang Gung Med J 2006; 29: 583-9.
12. Engleman HM, Martin SE, Deary IJ, et al. Effect of continuous positive airway pressure treatment on daytime function in sleep apnoea/hypopnoea syndrome. Lancet 1994; 343: 572-5.
13. Jenkinson C, Davies RJ, Mullins R, et al. Comparison of therapeutic and subtherapeutic nasal continuous positive airway pressure for obstructive sleep apnoea: A randomised prospective parallel trial. Lancet 1999; 353: 2100-5.
14. 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.
15. Lloberes P, Ballester E, Montserrat JM, et al. Comparison of manual and automatic CPAP titration in patients with sleep apnea/hypopnea syndrome. Am J Respir Crit Care Med 1996; 154: 1755-8.
16. Choi JH, Kim EJ, Kim KW, et al. Optimal continuous positive airway pressure level in Korean patients with obstructive sleep apnea syndrome. Clin Exp Otorhinolaryngol 2010; 3: 207-11.
17. Sforza E, Petiau C, Weiss T, et al. Pharyngeal critical pressure in patients with obstructive sleep apnea syndrome. Clinical implications. Am J Respir Crit Care Med 1999; 159: 149-57.
18. Stradling JR, Hardinge M, Paxton J, et al. Relative accuracy of algorithm-based prescription of nasal CPAP in OSA. Respir Med 2004; 98: 152-4.
19. Loredo JS, Berry C, Nelesen RA, et al. Prediction of continuous positive airway pressure in obstructive sleep apnea. Sleep Breath 2007; 11: 45-51.
20. Morgenthaler TI, Aurora RN, Brown T, 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.
21. Hoffstein V, Mateika S. Predicting nasal continuous positive airway pressure. Am J Respir Crit Care Med 1994; 150: 486-8.
22. Oliver Z, Hoffstein V. Predicting effective continuous positive airway pressure. Chest 2000; 117: 1061-4.
23. Lee GH, Kim MJ, Lee EM, et al. Prediction of optimal CPAP pressure and validation of an equation for Asian patients with obstructive sleep apnea. Respir Care 2013; 58: 810-5.
24. Villaneuva AT, Buchanan PR, Yee BJ, et al. Ethnicity and obstructive sleep apnoea. Sleep Med Rev 2005; 9: 419-36.
25. Gokcebay N, Iqbal S, Yang K, et al. Accuracy of CPAP predicted from anthropometric and polysomnographic indices. Sleep 1996; 19: 600-1.
26. Schiza SE, Bouloukaki I, Mermigkis C, et al. Utility of formulas predicting the optimal nasal continuous positive airway pressure in a Greek population. Sleep Breath 2011; 15: 417-23.
27. Akahoshi T, Akashiba T, Kawahara S, et al. Predicting optimal continuous positive airway pressure in Japanese patients with obstructive sleep apnoea syndrome. Respirology 2009; 14: 245-50.
28. Lin IF, Chuang ML, Liao YF, et al. Predicting effective continuous positive airway pressure in Taiwanese patients with obstructive sleep apnea syndrome. J Formos Med Assoc 2003; 102: 215-21.
29. Chuang ML, Lin IF, Vintch JR, et al. Predicting continuous positive airway pressure from a modified split-night protocol in moderate to severe obstructive sleep apnea-hypopnea syndrome. Intern Med 2008; 47: 1585-92.
30. Kushida CA, Chediak A, Berry RB, et al. Clinical guidelines for the manual titration of positive airway pressure in patients with obstructive sleep apnea. J Clin Sleep Med 2008; 4: 157-71.
31. Hukins CA. Arbitrary-pressure continuous positive airway pressure for obstructive sleep apnea syndrome. Am J Respir Crit Care Med 2005; 171: 500-5.
32. Redline S, Kump K, Tishler PV, et al. Gender differences in sleep disordered breathing in a community-based sample. Am J Respir Crit Care Med 1994; 149: 722-6.
33. Camacho M, Riaz M, Tahoori A, et al. Mathematical equations to predict positive airway pressures for obstructive sleep apnea: A systematic review. Sleep Disord 2015; 2015: 293868.
34. Khawaja IS, Olson EJ, van der Walt C, et al. Diagnostic accuracy of split-night polysomnograms. J Clin Sleep Med 2010; 6: 357-62.
35. Sanders MH, Kern NB, Costantino JP, et al. Adequacy of prescribing positive airway pressure therapy by mask for sleep apnea on the basis of a partialnight trial. Am Rev Respir Dis 1993; 147: 1169-74.
36. Nelson S, Hans M. Contribution of craniofacial risk factors in increasing apneic activity among obese and nonobese habitual snorers. Chest 1997; 111: 154-62.
37. Li KK, Kushida C, Powell NB, et al. Obstructive sleep apnea syndrome: a comparison between FarEast Asian and white men. Laryngoscope 2000; 110: 1689-93.
38. Li KK, Powell NB, Kushida C, et al. A comparison of Asian and white patients with obstructive sleep apnea syndrome. Laryngoscope 1999; 109: 1937-40.
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