Shane A Landry1,2, Simon A Joosten3,4,5, Scott A Sands6, David P White6, Atul Malhotra6,7, Andrew Wellman6, Garun S Hamilton3,4,5, Bradley A Edwards1,2,6. 1. Department of Physiology, Monash University, Melbourne, Victoria, Australia. 2. Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Melbourne, Victoria, Australia. 3. Monash Lung and Sleep, Monash Health, Melbourne, Victoria, Australia. 4. School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia. 5. Monash Partners - Epworth, Melbourne, Victoria, Australia. 6. Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham & Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA. 7. Division of Pulmonary and Critical Care Medicine, University of California San Diego, La Jolla, California, USA.
Abstract
BACKGROUND AND OBJECTIVE: Upper airway collapsibility predicts the response to several non-continuous positive airway pressure (CPAP) interventions for obstructive sleep apnoea (OSA). Measures of upper airway collapsibility cannot be easily performed in a clinical context; however, a patient's therapeutic CPAP requirement may serve as a surrogate measure of collapsibility. The present work aimed to compare the predictive use of CPAP level with detailed physiological measures of collapsibility. METHODS:Therapeutic CPAP levels and gold-standard pharyngeal collapsibility measures (passive pharyngeal critical closing pressure (Pcrit ) and ventilation at CPAP level of 0 cmH2 O (Vpassive )) were retrospectively analysed from a randomized controlled trial (n = 20) comparing the combination of oxygen and eszopiclone (treatment) versus placebo/air control. Responders (9/20) to treatment were defined as those who exhibited a 50% reduction in apnoea/hypopnoea index (AHI) plus an AHI<15 events/h on-therapy. RESULTS: Responders to treatment had a lower therapeutic CPAP requirement compared with non-responders (6.6 (5.4-8.1) cmH2 O vs 8.9 (8.4-10.4) cmH2 O, P = 0.007), consistent with their reduced collapsibility (lower Pcrit , P = 0.017, higher Vpassive P = 0.025). Therapeutic CPAP level provided the highest predictive accuracy for differentiating responders from non-responders (area under the curve (AUC) = 0.86 ± 0.9, 95% CI: 0.68-1.00, P = 0.007). However, both Pcrit (AUC = 0.83 ± 0.11, 95% CI: 0.62-1.00, P = 0.017) and Vpassive (AUC = 0.77 ± 0.12, 95% CI: 0.53-1.00, P = 0.44) performed well, and the difference in AUC for these three metrics was not statistically different. A therapeutic CPAP level ≤8 cmH2 O provided 78% sensitivity and 82% specificity (positive predictive value = 78%, negative predictive value = 82%) for predicting a response to these therapies. CONCLUSION:Therapeutic CPAP requirement, as a surrogate measure of pharyngeal collapsibility, predicts the response to non-anatomical therapy (oxygen and eszopiclone) for OSA.
RCT Entities:
BACKGROUND AND OBJECTIVE: Upper airway collapsibility predicts the response to several non-continuous positive airway pressure (CPAP) interventions for obstructive sleep apnoea (OSA). Measures of upper airway collapsibility cannot be easily performed in a clinical context; however, a patient's therapeutic CPAP requirement may serve as a surrogate measure of collapsibility. The present work aimed to compare the predictive use of CPAP level with detailed physiological measures of collapsibility. METHODS: Therapeutic CPAP levels and gold-standard pharyngeal collapsibility measures (passive pharyngeal critical closing pressure (Pcrit ) and ventilation at CPAP level of 0 cmH2 O (Vpassive )) were retrospectively analysed from a randomized controlled trial (n = 20) comparing the combination of oxygen and eszopiclone (treatment) versus placebo/air control. Responders (9/20) to treatment were defined as those who exhibited a 50% reduction in apnoea/hypopnoea index (AHI) plus an AHI<15 events/h on-therapy. RESULTS: Responders to treatment had a lower therapeutic CPAP requirement compared with non-responders (6.6 (5.4-8.1) cmH2 O vs 8.9 (8.4-10.4) cmH2 O, P = 0.007), consistent with their reduced collapsibility (lower Pcrit , P = 0.017, higher Vpassive P = 0.025). Therapeutic CPAP level provided the highest predictive accuracy for differentiating responders from non-responders (area under the curve (AUC) = 0.86 ± 0.9, 95% CI: 0.68-1.00, P = 0.007). However, both Pcrit (AUC = 0.83 ± 0.11, 95% CI: 0.62-1.00, P = 0.017) and Vpassive (AUC = 0.77 ± 0.12, 95% CI: 0.53-1.00, P = 0.44) performed well, and the difference in AUC for these three metrics was not statistically different. A therapeutic CPAP level ≤8 cmH2 O provided 78% sensitivity and 82% specificity (positive predictive value = 78%, negative predictive value = 82%) for predicting a response to these therapies. CONCLUSION: Therapeutic CPAP requirement, as a surrogate measure of pharyngeal collapsibility, predicts the response to non-anatomical therapy (oxygen and eszopiclone) for OSA.
Authors: Bradley A Edwards; Scott A Sands; Robert L Owens; Danny J Eckert; Shane Landry; David P White; Atul Malhotra; Andrew Wellman Journal: Sleep Date: 2016-11-01 Impact factor: 5.849
Authors: Kate Sutherland; Craig L Phillips; Amanda Davies; Vasanth K Srinivasan; Oyku Dalci; Brendon J Yee; M Ali Darendeliler; Ronald R Grunstein; Peter A Cistulli Journal: J Clin Sleep Med Date: 2014-09-15 Impact factor: 4.062
Authors: Shane A Landry; Simon A Joosten; Danny J Eckert; Amy S Jordan; Scott A Sands; David P White; Atul Malhotra; Andrew Wellman; Garun S Hamilton; Bradley A Edwards Journal: Sleep Date: 2017-06-01 Impact factor: 5.849
Authors: Philip I Terrill; Bradley A Edwards; Shamim Nemati; James P Butler; Robert L Owens; Danny J Eckert; David P White; Atul Malhotra; Andrew Wellman; Scott A Sands Journal: Eur Respir J Date: 2014-10-16 Impact factor: 16.671
Authors: Danny J Eckert; David P White; Amy S Jordan; Atul Malhotra; Andrew Wellman Journal: Am J Respir Crit Care Med Date: 2013-10-15 Impact factor: 21.405
Authors: Jeremy E Orr; Christopher N Schmickl; Bradley A Edwards; Pamela N DeYoung; Rebbecca Brena; Xiaoying S Sun; Sonia Jain; Atul Malhotra; Robert L Owens Journal: Physiol Rep Date: 2020-02