Michael V Braganza1, Patrick J Hanly1,2, Kristin L Fraser1,2, Willis H Tsai1,2,3, Sachin R Pendharkar1,2,3. 1. Sleep Centre, Foothills Medical Centre, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. 2. Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. 3. Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
Abstract
STUDY OBJECTIVES: Home sleep apnea testing (HSAT) is commonly used to diagnose obstructive sleep apnea, but its role in identifying patients with suspected hypoventilation or predicting their response to continuous positive airway pressure (CPAP) therapy has not been assessed. The primary objective was to determine if HSAT, combined with clinical variables, could predict the failure of CPAP to correct nocturnal hypoxemia during polysomnography in a population with suspected hypoventilation. Secondary objectives were to determine if HSAT and clinical parameters could predict awake or sleep hypoventilation. METHODS: A retrospective review was performed of 142 consecutive patients who underwent split-night polysomnography for suspected hypoventilation after clinical assessment by a sleep physician and review of HSAT. We collected quantitative indices of nocturnal hypoxemia, patient demographics, medications, pulmonary function tests, as well as arterial blood gas data from the night of the polysomnography . CPAP failure was defined as persistent obstructive sleep apnea, hypoxemia (oxygen saturation measured by pulse oximetry < 85%), or hypercapnia despite maximal CPAP. RESULTS: Failure of CPAP was predicted by awake oxygen saturation and arterial blood gas results but not by HSAT indices of nocturnal hypoxemia. Awake oxygen saturation ≥ 94% ruled out CPAP failure, and partial pressure of oxygen measured by arterial blood gas ≥ 68 mmHg decreased the likelihood of CPAP failure significantly. CONCLUSIONS: In patients with suspected hypoventilation based on clinical review and HSAT interpretation by a sleep physician, awake oxygen saturation measured by pulse oximetry and partial pressure of oxygen measured by arterial blood gas can reliably identify patients in whom CPAP is likely to fail. Additional research is required to determine the role of HSAT in the identification and treatment of patients with hypoventilation.
STUDY OBJECTIVES: Home sleep apnea testing (HSAT) is commonly used to diagnose obstructive sleep apnea, but its role in identifying patients with suspected hypoventilation or predicting their response to continuous positive airway pressure (CPAP) therapy has not been assessed. The primary objective was to determine if HSAT, combined with clinical variables, could predict the failure of CPAP to correct nocturnal hypoxemia during polysomnography in a population with suspected hypoventilation. Secondary objectives were to determine if HSAT and clinical parameters could predict awake or sleep hypoventilation. METHODS: A retrospective review was performed of 142 consecutive patients who underwent split-night polysomnography for suspected hypoventilation after clinical assessment by a sleep physician and review of HSAT. We collected quantitative indices of nocturnal hypoxemia, patient demographics, medications, pulmonary function tests, as well as arterial blood gas data from the night of the polysomnography . CPAP failure was defined as persistent obstructive sleep apnea, hypoxemia (oxygen saturation measured by pulse oximetry < 85%), or hypercapnia despite maximal CPAP. RESULTS: Failure of CPAP was predicted by awake oxygen saturation and arterial blood gas results but not by HSAT indices of nocturnal hypoxemia. Awake oxygen saturation ≥ 94% ruled out CPAP failure, and partial pressure of oxygen measured by arterial blood gas ≥ 68 mmHg decreased the likelihood of CPAP failure significantly. CONCLUSIONS: In patients with suspected hypoventilation based on clinical review and HSAT interpretation by a sleep physician, awake oxygen saturation measured by pulse oximetry and partial pressure of oxygen measured by arterial blood gas can reliably identify patients in whom CPAP is likely to fail. Additional research is required to determine the role of HSAT in the identification and treatment of patients with hypoventilation.
Authors: Mark E Howard; Amanda J Piper; Bronwyn Stevens; Anne E Holland; Brendon J Yee; Eli Dabscheck; Duncan Mortimer; Angela T Burge; Daniel Flunt; Catherine Buchan; Linda Rautela; Nicole Sheers; David Hillman; David J Berlowitz Journal: Thorax Date: 2016-11-15 Impact factor: 9.139
Authors: Yewon Chung; Frances L Garden; Adelle S Jee; Subash Srikantha; Saurabh Gupta; Peter R Buchanan; Peter W Collett; Guy B Marks; Hima Vedam Journal: Intern Med J Date: 2017-10 Impact factor: 2.048
Authors: Vishesh K Kapur; Dennis H Auckley; Susmita Chowdhuri; David C Kuhlmann; Reena Mehra; Kannan Ramar; Christopher G Harrod Journal: J Clin Sleep Med Date: 2017-03-15 Impact factor: 4.062
Authors: Babak Mokhlesi; Juan Fernando Masa; Jan L Brozek; Indira Gurubhagavatula; Patrick B Murphy; Amanda J Piper; Aiman Tulaimat; Majid Afshar; Jay S Balachandran; Raed A Dweik; Ronald R Grunstein; Nicholas Hart; Roop Kaw; Geraldo Lorenzi-Filho; Sushmita Pamidi; Bhakti K Patel; Susheel P Patil; Jean Louis Pépin; Israa Soghier; Maximiliano Tamae Kakazu; Mihaela Teodorescu Journal: Am J Respir Crit Care Med Date: 2019-08-01 Impact factor: 21.405
Authors: Magdy K Younes; Andrew E Beaudin; Jill K Raneri; Beth J Gerardy; Patrick J Hanly Journal: J Clin Sleep Med Date: 2022-08-01 Impact factor: 4.324
Authors: Andrew E Beaudin; Jill K Raneri; Najib T Ayas; Robert P Skomro; Eric E Smith; Patrick J Hanly Journal: J Clin Sleep Med Date: 2022-01-01 Impact factor: 4.062