Determinants of bilevel therapy in the management of obstructive sleep apnea
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HYPOXIA • ORIGINAL ARTICLE
Determinants of bilevel therapy in the management of obstructive sleep apnea Stuart Shah 1 & Carmen Smotherman 1 & Mariam Louis 1 Received: 24 June 2020 / Revised: 28 August 2020 / Accepted: 12 September 2020 # Springer Nature Switzerland AG 2020
Abstract Background The aim of this study was to investigate potential patient or polysomnogram (PSG) characteristics that can help determine who might benefit from bilevel positive airway pressure (BPAP) in the treatment of uncomplicated OSA. Study design This was a single center, retrospective, observational study in which 19 patients who met our inclusion criteria for BPAP were matched to 40 patients in the control group. Data on patient baseline characteristics as well as PSG results were analyzed. Results Baseline patient and PSG characteristics were similar with the exception of shorter sleep time in the BPAP group, 290 min compared with 351 min (p = 0.005). Analysis of oxygen saturations revealed that the percent of total sleep time (TST) spent below 90% (SpO2 < 90%) was statistically higher in BPAP group (mean 21.4% ± 23.6%) compared with CPAP (mean 9.1% ± 11.1%, p = 0.045). For every 5% increase in TST at SpO2 < 90%, there is a 28% increase in the odds of BPAP prescription (OR = 1.276, 95%CI 1.029, 1.582, p = 0.027), and for every 10% increase, there is an increase of 63% (OR 1.627, 95%CI 1.058–2.502). The Hosmer-Lemeshow goodness-of-fit test revealed a good fit (p = 0.23). The AUC was 0.7. Conclusion There is an association between duration of hypoxemia on the PSG and the likelihood of requiring BPAP for the treatment of uncomplicated OSA. More research is needed to understand the best patient-centered therapy when initiating PAP in the management of OSA. Keywords Sleep . OSA . BPAP . CPAP . Hypoxemia
Abbreviations AASM American Academy of Sleep Medicine AHI Apnea hypopnea index BMI Body mass index BPAP Bilevel positive airway pressure CAD Coronary artery disease CHF Congestive heart failure CKD Chronic kidney disease COPD Chronic obstructive pulmonary disease CPAP Continuous positive airway pressure ECG Electrocardiogram EEG Electroencephalogram EMG Electromyography
EOG ESRD ESS NREM OHS OSA pHTN PSG REM ROC TST WASO
* Mariam Louis [email protected]
Introduction
1
Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida, Jacksonville Suite 7-088, C-54 UF Health Clinical Center, 655 west 8th Street, Jacksonville, FL 32209, USA
Electrooculogram End-stage renal disease Epworth sleepiness scale Non-rapid eye movement Obesity hypoventilation syndrome Obstructive sleep apnea Pulmonary hypertension Polysomnography Rapid eye movement Receiver operating characteristic Total sleep time Wake after sleep onset
Obstructive sleep apnea (OSA) is a disorder in which repetitive airway collapse occurs during sleep. This can lead to intermittent desaturations and poor sleep quality. In a recent
Sleep Breath
guideline published by the American Academy of Sleep Medicine (AASM), continuous positive airway pressure (
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