TY - JOUR T1 - Factors Affecting Optimal Continuous Positive Airway Pressure Level in Patients with Obstructive Sleep Apnea Syndrome TT - Obstrüktif Uyku Apne Sendromlu Hastalarda Optimal Sürekli Pozitif Havayolu Basınç Düzeyini Etkileyen Faktörler AU - Sayhan Kaplan, Havva AU - Günbatar, Hülya PY - 2020 DA - March DO - 10.31832/smj.678074 JF - Sakarya Tıp Dergisi PB - Sakarya University WT - DergiPark SN - 2146-409X SP - 99 EP - 106 VL - 10 IS - 1 LA - en AB - AbstractObjectives: Thisstudy aimed to examine factors (BMI, neck circumference, AHI etc.) affectingoptimal CPAP levels in patients with obstructive sleep apnea syndrome (OSAS).Materialsand Methods: A total of 120 patients with OSAS whounderwent successful auto-titration for CPAP treatment were included in thisstudy. Correlations between the optimal CPAP level and baseline data wereanalyzed.Results: Themean optimal pressure level in the 120 OSAS patients was 9.11 ± 2.81 cm H2O.The mean optimal pressure levels in the mild, moderate, and severe OSAS groups were8.01 ± 2.60, 8.32 ± 2.22, and 9.71 ± 3.01 cm H2O, respectively.Apnea/hypopnea index (AHI) (r=0.297, p<0.001) and minimal SaO2(r=-0.264, p<0.004) were significantly correlated with optimal pressurelevel. 22 patients in the titration failure group had severe AHI overall; 6patients had REM-related and 2 had position-related OSAS. Patients in the titrationfailure group who did not have a specific diagnosis (rapid eye movement (REM)or positional OSAS) had very severe AHI levels (mean AHI of 67.90). Conclusion: Accordingto the correlation tests, AHI and the lowest saturation were the two mostimportant predictors of optimal CPAP level. KW - Obstructive sleep apnea syndrome KW - Continuous positive airway pressure KW - apnea KW - polysomnography N2 - ÖzAmaç: Buçalışmada obstrüktif uyku apne sendromu (OUAS) olan hastalarda optimal CPAPdüzeylerini etkileyen faktörlerin (VKİ, boyun çevresi, AHİ vb.) araştırılılmasıamaçlandı.Gereçve Yöntem: Bu çalışmaya CPAP tedavisi için başarılı oto titrasyonuygulanan 120 OUAS hastası dahil edildi. Optimal CPAP seviyesi ile başlangıç​​verileri arasındaki korelasyonlar analiz edildi.Bulgular: 120OUAS hastasında ortalama optimal basınç seviyesi 9.11 ± 2.81 cm H2Oidi. Hafif, orta ve şiddetli OUAS gruplarında ortalama optimal basınç seviyelerisırasıyla 8.01 ± 2.60, 8.32 ± 2.22 ve 9.71 ± 3.01 cm H2O idi. Apne /hipopne indeksi (AHI) (r = 0.297, p <0.001) ve minimal SaO2 (r =-0.264, p <0.004) optimal basınç seviyesi ile anlamlı korelasyon gösterdi.Titrasyon yetmezliği grubundaki 22 hastada genel olarak ağır AHI vardı; 6hastada REM ilişkili, 2 hastada pozisyona bağlı OUAS mevcuttu. Titrasyonyetmezliği grubunda, belirli bir tanısı (hızlı göz hareketi (REM) veya pozisyonOUAS) bulunmayan hastalarda çok ciddi AHI düzeyleri vardı (ortalama AHI 67.90idi).Sonuç: Korelasyontestlerine göre optimal CPAP seviyesinin en önemli iki belirleyicisi AHI ve endüşük saturasyon olarak bulundu. CR - 1- 1- Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med. 1993 Apr 29;328(17):1230-5. CR - 2- Peppard PE, Young T, Barnet JH, Palta M, Hagen EW, Hla KM. Increased prevalence of sleep-disordered breathing in adults. Am J Epidemiol. 2013;177(9):1006-1014 CR - 3- Young T, Finn L, Peppard PE, et al. Sleep disordered breathing and mortality: eighteen year follow up of the Wisconsin Sleep Cohort. Sleep 2008; 31: 1071–8P CR - 4- Kaw R, Michota F, Jaffer A, Ghamande S, Auckley D, Golish J. Unrecognized sleep apnea in the surgical patient: implications for the perioperative setting. Chest 2006; 129: 198–205 CR - 5- Liao P, Yegneswaran B, Vairavanathan S, Zilberman P, Chung F. Postoperative complications in patients with obstructive sleep apnea: a retrospective matched cohort study. Can J Anaesth 2009; 56: 819–28 6- Society of Anesthesia and Sleep Medicine Guidelines on Preoperative Screening and Assessment of Adult Patients With Obstructive Sleep Apnea.Chung F, Memtsoudis SG, Ramachandran SK, Nagappa M, Opperer M, Cozowicz C, Patrawala S, Lam D, Kumar A, Joshi GP, Fleetham J, Ayas N, Collop N, Doufas AG, Eikermann M, Englesakis M, Gali B, Gay P, Hernandez AV, Kaw R, Kezirian EJ, Malhotra A, Mokhlesi B, Parthasarathy S, Stierer T, Wappler F, Hillman DR, Auckley D .Anesth Analg. 2016;123(2):452. CR - 7- Epstein LJ, Kristo D, Strollo PJ Jr, Friedman N, Malhotra A, Patil SP, et al. Clinical guideline for the evaluation, management and longterm care of obstructive sleep apnea in adults. J Clin Sleep Med.2009 Jun 15;5(3):263-76. CR - 8- Morgenthaler TI, Aurora RN, Brown T, Zak R, Alessi C, Boehlecke B, et al. Practice parameters for the use of autotitrating continuous positive airway pressure devices for titrating pressures and treating adult patients with obstructive sleep apnea syndrome: an update for 2007. An American Academy of Sleep Medicine report. Sleep. 2008 Jan 1;31(1):141-7. CR - 9- Stepanski EJ, Dull R, Basner RC. CPAP titration protocols among accredited sleep disorder centers. Sleep Res 1996;25:374. CR - 10- Mokhlesi B, Tulaimat A. Recent advances in obesity hypoventilation syndrome. Chest 2007;132:1322-36. CR - 11- Sforza E, Krieger J, Bacon W, Petiau C, Zamagni M, Boudewijns A. Determinants of effective continuous positive airway pressurein obstructive sleep apnea. Role of respiratory effort. Am J RespirCrit Care Med 1995;151:1852-6. CR - 12- Sullivan CE, Issa FG, Berthon-Jones M, McCauley VB, Costas LJ. Home treatment of obstructive sleep apnoea with continuous positive airway pressure applied through a nose-mask. Bull Eur Physiopathol Respir 1984;20:49-54. CR - 13- Nino-Murcia G, McCann CC, Bliwise DL, Guilleminault C, De¬ment WC. Compliance and side effects in sleep apnea patients treated with nasal continuous positive airway pressure. West J Med 1989;150:165-9. CR - 14- Miljeteig H, Hoffstein V. Determinants of continuous positive air¬way pressure level for treatment of obstructive sleep apnea. Am Rev Respir Dis 1993;147(6 Pt 1):1526-30. CR - 15- Pevernagie DA, Shepard JW Jr. Relations between sleep stage, posture and effective nasal CPAP levels in OSA. Sleep 1992;15:162-7. CR - 16- Stepanski EJ. The need for a standardized CPAP titration protocol and follow-up procedures. J Clin Sleep Med 2005;1:311. CR - 17- Lin IF, Chuang ML, Liao YF, Chen NH, Li HY. Predicting effective continuous positive airway pressure in Taiwanese patients with obstructive sleep apnea syndrome. J Formos Med Assoc. 2003;102(4):215-21. CR - 18- Loredo JS, Berry C, Nelesen RA, Dimsdale JE. Prediction of continuous positive airway pressure in obstructive sleep apnea. Sleep Breath. 2007;11(1):45-51. CR - 19- Akahoshi T, Akashiba T, Kawahara S, Uematsu A, Nagaoka K, Kiyofuji K, et al. Predicting optimal continuous positive airway pressure in Japanese patients with obstructive sleep apnoea syndrome. Respirology. 2009;14(2):245-50. CR - 20- Rowley JA, Tarbichi AG, Badr MS. The use of a predicted CPAP equation improves CPAP titration success. Sleep Breath. 2005; 9(1):26-32. CR - 21- Masa JF, Jimenez A, Duran J, Capote F, Monasterio C, Mayos M, et al. Alternative methods of titrating continuous positive airway pressure: a large multicenter study. Am J Respir Crit Care Med. 2004, 1;170(11):1218-24. CR - 22- Kushida CA, Littner MR, Morgenthaler T, Alessi CA, Bailey D, Coleman Jr, et al. Practice parameters for the indications for polysomnography and related procedures: an update for 2005. Sleep. 2005;28(4):499-521. CR - 23- Hoffstein V, Mateika S. Predicting nasal continuous positive airway pressure. Am J Respir Med 1994 150:486–488 CR - 24- Oliver Z, Hoffstein V. Predicting effective continuous positive airway pressure. Chest 2000 117:1061–1064 CR - 25- Hertegonne KB, Volna J, Portier S, De Pauw R, Van Maele G, Pevernagie DA Titration procedures for nasal CPAP: automatic CPAP or prediction formula? Sleep Med 2008 9:732–738 CR - 26- El Solh AA, Aldik Z, Alnabhan M, Grant B Predicting effective continuous positive airway pressure in sleep apnea using an artificial neural network. Sleep Med 2007 8:471–477 CR - 27- Ozen K. Basoglu & Mehmet Sezai Tasbakan. Determination of new prediction formula for nasal continuous positive airway pressure in Turkish patients with obstructive sleep apnea syndrome Sleep Breath 2012 16:1121–1127 CR - 28- Habesoglu MA, Kokturk O. Obstrüktif Uyku Apne Sendromu Tedavisinde CPAP Titrasyon Basıncının Matematiksel Yöntemle Belirlenmesi. Turkiye Klinikleri Arch Lung 2007;8:74-7 UR - https://doi.org/10.31832/smj.678074 L1 - https://dergipark.org.tr/en/download/article-file/999275 ER -