Robert L Owens1, Bradley A Edwards1, Danny J Eckert2, Amy S Jordan3, Scott A Sands1, Atul Malhotra4, David P White1, Stephen H Loring5, James P Butler1, Andrew Wellman1. 1. Sleep Disorders Research Program, Division of Sleep Medicine, Brigham and Women's and Harvard Medical School, Boston, MA. 2. Neuroscience Research Australia (NeuRA) and the School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia. 3. Melbourne School of Physiological Sciences, University of Melbourne, Melbourne, Victoria, Australia. 4. Pulmonary and Critical Care Division, University of California - San Diego, La Jolla, CA. 5. Department of Anesthesia and Critical Care, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA.
Abstract
STUDY OBJECTIVES: Both anatomical and nonanatomical traits are important in obstructive sleep apnea (OSA) pathogenesis. We have previously described a model combining these traits, but have not determined its diagnostic accuracy to predict OSA. A valid model, and knowledge of the published effect sizes of trait manipulation, would also allow us to predict the number of patients with OSA who might be effectively treated without using positive airway pressure (PAP). DESIGN, PARTICIPANTS AND INTERVENTION: Fifty-seven subjects with and without OSA underwent standard clinical and research sleep studies to measure OSA severity and the physiological traits important for OSA pathogenesis, respectively. The traits were incorporated into a physiological model to predict OSA. The model validity was determined by comparing the model prediction of OSA to the clinical diagnosis of OSA. The effect of various trait manipulations was then simulated to predict the proportion of patients treated by each intervention. MEASUREMENTS AND RESULTS: The model had good sensitivity (80%) and specificity (100%) for predicting OSA. A single intervention on one trait would be predicted to treat OSA in approximately one quarter of all patients. Combination therapy with two interventions was predicted to treat OSA in ∼50% of patients. CONCLUSIONS: An integrative model of physiological traits can be used to predict population-wide and individual responses to non-PAP therapy. Many patients with OSA would be expected to be treated based on known trait manipulations, making a strong case for the importance of non-anatomical traits in OSA pathogenesis and the effectiveness of non-PAP therapies.
STUDY OBJECTIVES: Both anatomical and nonanatomical traits are important in obstructive sleep apnea (OSA) pathogenesis. We have previously described a model combining these traits, but have not determined its diagnostic accuracy to predict OSA. A valid model, and knowledge of the published effect sizes of trait manipulation, would also allow us to predict the number of patients with OSA who might be effectively treated without using positive airway pressure (PAP). DESIGN, PARTICIPANTS AND INTERVENTION: Fifty-seven subjects with and without OSA underwent standard clinical and research sleep studies to measure OSA severity and the physiological traits important for OSA pathogenesis, respectively. The traits were incorporated into a physiological model to predict OSA. The model validity was determined by comparing the model prediction of OSA to the clinical diagnosis of OSA. The effect of various trait manipulations was then simulated to predict the proportion of patients treated by each intervention. MEASUREMENTS AND RESULTS: The model had good sensitivity (80%) and specificity (100%) for predicting OSA. A single intervention on one trait would be predicted to treat OSA in approximately one quarter of all patients. Combination therapy with two interventions was predicted to treat OSA in ∼50% of patients. CONCLUSIONS: An integrative model of physiological traits can be used to predict population-wide and individual responses to non-PAP therapy. Many patients with OSA would be expected to be treated based on known trait manipulations, making a strong case for the importance of non-anatomical traits in OSA pathogenesis and the effectiveness of non-PAP therapies.
Authors: A R Schwartz; N Schubert; W Rothman; F Godley; B Marsh; D Eisele; J Nadeau; L Permutt; I Gleadhill; P L Smith Journal: Am Rev Respir Dis Date: 1992-03
Authors: N B Kribbs; A I Pack; L R Kline; P L Smith; A R Schwartz; N M Schubert; S Redline; J N Henry; J E Getsy; D F Dinges Journal: Am Rev Respir Dis Date: 1993-04
Authors: Andrew Wellman; Atul Malhotra; Amy S Jordan; Karen E Stevenson; Shiva Gautam; David P White Journal: Respir Physiol Neurobiol Date: 2008-06-03 Impact factor: 1.931
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