Kontinuerlig positivt trykk i luftveiene kan predikere resultatet av apnéskinnebehandling

 

Målet med denne studien var å vurdere om CPAP-trykk kan predikere behandlingsresultatet med apnéskinne hos pasienter med lav CPAP etterlevelse. Tidligere studier viser at det er sammenheng mellom terapeutisk CPAP-trykk og behandlingsresultatet med apnéskinne hos pasienter med obstruktiv søvnapné (OSA), men disse studiene inkluderte enten pasienter som brukte CPAP med fast trykk eller pasienter med delvis lav CPAP etterlevelse. I mange land brukes hovedsakelig auto-CPAP, og bare pasienter med lav etterlevelse får tilbud om apnéskinnebehandling. Studier som undersøker forholdet mellom CPAP-trykk og behandlingsresultat med apnéskinne bør derfor fokusere på disse pasientene.

I denne studien ble 87 pasienter med moderat eller alvorlig OSA inkludert. Pasienter med AHI under 5 ble sammenlignet med pasienter som hadde AHI mellom 5 og 10 og som hadde mer enn 50 % reduksjon i AHI. Resultatene viste at maksimalt CPAP-trykk var en moderat prediktor for behandlingsresultatet av apnéskinne, men i kombinasjon med AHI før behandling var muligheten for å identifisere non-respondere for apnéskinnebehandling høy.

Oral appliance treatment outcome can be predicted by continuous positive airway pressure in moderate to severe obstructive sleep apnea.


Studien er publisert i Sleep Breath

 

Anders Storesund, Anders Johansson, Bjørn Bjorvatn, Sverre Lehmann.

Studies show that the therapeutic CPAP pressure is associated with oral appliance (OA) treatment outcome in obstructive sleep apnea (OSA) patients. However, these studies included either CPAP adherent patients using fixed pressure devices, or partly CPAP non-adherent patients using fixed pressure or auto-adjusting (auto-CPAP) devices. In many countries, auto-CPAP is predominately used, and only those non-adherent to therapy need a change to OA. Therefore, studies examining the relationship between CPAP pressures and OA treatment outcome should focus on patients non-adherent to auto-CPAP.

The purpose of this paper is to assess if CPAP pressures predicted OA treatment outcome in patients non-adherent to auto-CPAP therapy.

The OA treatment responders and non-responders were defined by two success criteria ((1) AHI < 5; (2) 5 ≤ AHI < 10 and > 50% AHI reduction). Logistic regression analyses were performed for CPAP pressures and baseline variables. ROC curve analyses were used to identify CPAP pressure cutoff values, alone and combined with other explanatory variables, predicting the OA treatment outcome.

Eighty-seven patients with moderate or severe OSA were included. Maximum CPAP pressures (CPAPmax) were higher in non-responders by both criteria and were, together with baseline AHI, associated with the OA treatment outcome in multivariate regression analyses. ROC curves identified an optimal CPAPmax cutoff of 12 cm H2O, corresponding to a positive predictive value (PPV) of 0.85 in predicting non-response using criterion 1. A prediction model combining CPAPmax > 12 and baseline AHI ≥ 30 had a PPV of 1.0 for non-response by both criteria.

Maximum CPAP pressure was a moderate predictor of OA treatment outcome, but combined with baseline AHI, the ability to identify OA non-responders was high.