M J L Ravesloot1, N de Vries. 1. Sint Lucas Andreas Ziekenhuis, Department of Otolaryngology/Head Neck Surgery, Amsterdam, the Netherlands. m.ravesloot@slaz.nl
Abstract
BACKGROUND: Various treatment methods exist to treat obstructive sleep apnea (OSA); continuous positive airway pressure (CPAP) is considered the gold standard. It is however a clinical reality that the use of CPAP is often cumbersome. CPAP treatment is considered compliant when used ≥ 4 h per night as an average over all nights observed. Surgery, on the other hand, is regarded as successful when the apnea hypopnea index (AHI) drops at least 50% and is reduced below 20/h postoperatively in patients whose preoperative AHI was > 20/h. The effectiveness of CPAP compliance criteria can be questioned, just as the effectiveness of surgical success criteria has often been questioned. STUDY OBJECTIVES: The aim of the study was to compare non optimal use of optimal therapy (CPAP) with the continuous effect (100%) of often non optimal therapy (surgery). DESIGN: Using mathematical function formulas, the effect on the AHI of various treatment modalities and their respective compliance and success criteria were calculated. RESULTS: The more severe the AHI, the more percentage of total sleep time (TST) CPAP must be used to significantly reduce the AHI. Patients with moderate OSA reduce the AHI by 33.3% to 48.3% when using CPAP 4 h/ night (AHI 0-5, respectively). The required nightly percentage use rises as one reduces the AHI target to < 5. CPAP must be used 66.67% to 83.33% per night to reduce the AHI below 5 (AHI of 0 while using CPAP). CONCLUSION: Using a mean AHI in CPAP therapy is more realistic than using arbitrary compliance rates, which, in fact, hide insufficient reductions in AHI.
BACKGROUND: Various treatment methods exist to treat obstructive sleep apnea (OSA); continuous positive airway pressure (CPAP) is considered the gold standard. It is however a clinical reality that the use of CPAP is often cumbersome. CPAP treatment is considered compliant when used ≥ 4 h per night as an average over all nights observed. Surgery, on the other hand, is regarded as successful when the apnea hypopnea index (AHI) drops at least 50% and is reduced below 20/h postoperatively in patients whose preoperative AHI was > 20/h. The effectiveness of CPAP compliance criteria can be questioned, just as the effectiveness of surgical success criteria has often been questioned. STUDY OBJECTIVES: The aim of the study was to compare non optimal use of optimal therapy (CPAP) with the continuous effect (100%) of often non optimal therapy (surgery). DESIGN: Using mathematical function formulas, the effect on the AHI of various treatment modalities and their respective compliance and success criteria were calculated. RESULTS: The more severe the AHI, the more percentage of total sleep time (TST) CPAP must be used to significantly reduce the AHI. Patients with moderate OSA reduce the AHI by 33.3% to 48.3% when using CPAP 4 h/ night (AHI 0-5, respectively). The required nightly percentage use rises as one reduces the AHI target to < 5. CPAP must be used 66.67% to 83.33% per night to reduce the AHI below 5 (AHI of 0 while using CPAP). CONCLUSION: Using a mean AHI in CPAP therapy is more realistic than using arbitrary compliance rates, which, in fact, hide insufficient reductions in AHI.
Authors: Maree Barnes; Danielle Houston; Christopher J Worsnop; Alister M Neill; Ivanka J Mykytyn; Amanda Kay; John Trinder; Nicholas A Saunders; R Douglas McEvoy; Robert J Pierce Journal: Am J Respir Crit Care Med Date: 2002-03-15 Impact factor: 21.405
Authors: Karl A Franklin; Heidi Anttila; Susanna Axelsson; Thorarinn Gislason; Paula Maasilta; Kurt I Myhre; Nina Rehnqvist Journal: Sleep Date: 2009-01 Impact factor: 5.849
Authors: Terri E Weaver; Greg Maislin; David F Dinges; Thomas Bloxham; Charles F P George; Harly Greenberg; Gihan Kader; Mark Mahowald; Joel Younger; Allan I Pack Journal: Sleep Date: 2007-06 Impact factor: 5.849
Authors: Eric J Kezirian; Edward M Weaver; Mark A Criswell; Nico de Vries; B Tucker Woodson; Jay F Piccirillo Journal: Otolaryngol Head Neck Surg Date: 2011-02-14 Impact factor: 3.497
Authors: Olivier M Vanderveken; Joachim T Maurer; Winfried Hohenhorst; Evert Hamans; Ho-Sheng Lin; Anneclaire V Vroegop; Clemens Anders; Nico de Vries; Paul H Van de Heyning Journal: J Clin Sleep Med Date: 2013-05-15 Impact factor: 4.062