Obstrüktif Uyku Apne Sendromlu Hastalarda Optimal Sürekli Pozitif Havayolu Basınç Düzeyini Etkileyen Faktörler

Abstract

Öz

Amaç: Bu çalışmada obstrüktif uyku apne sendromu (OUAS) olan hastalarda optimal CPAP düzeylerini etkileyen faktörlerin (VKİ, boyun çevresi, AHİ vb.) araştırılılması amaçlandı.

Gereç ve Yöntem: Bu çalışmaya CPAP tedavisi için başarılı oto titrasyon uygulanan 120 OUAS hastası dahil edildi. Optimal CPAP seviyesi ile başlangıç ​​verileri arasındaki korelasyonlar analiz edildi.

Bulgular: 120 OUAS hastasında ortalama optimal basınç seviyesi 9.11 ± 2.81 cm H₂O idi. Hafif, orta ve şiddetli OUAS gruplarında ortalama optimal basınç seviyeleri sırasıyla 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; 6 hastada REM ilişkili, 2 hastada pozisyona bağlı OUAS mevcuttu. Titrasyon yetmezliği grubunda, belirli bir tanısı (hızlı göz hareketi (REM) veya pozisyon OUAS) bulunmayan hastalarda çok ciddi AHI düzeyleri vardı (ortalama AHI 67.90 idi).

Sonuç: Korelasyon testlerine göre optimal CPAP seviyesinin en önemli iki belirleyicisi AHI ve en düşük saturasyon olarak bulundu.

Keywords

• Obstrüktif uyku apne sendromu,Sürekli pozitif havayolu basıncı,apne,Polisomnografi

Factors Affecting Optimal Continuous Positive Airway Pressure Level in Patients with Obstructive Sleep Apnea Syndrome

Abstract

Abstract

Objectives: This study aimed to examine factors (BMI, neck circumference, AHI etc.) affecting optimal CPAP levels in patients with obstructive sleep apnea syndrome (OSAS).

Materials and Methods: A total of 120 patients with OSAS who underwent successful auto-titration for CPAP treatment were included in this study. Correlations between the optimal CPAP level and baseline data were analyzed.

Results: The mean 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 were 8.01 ± 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 pressure level. 22 patients in the titration failure group had severe AHI overall; 6 patients had REM-related and 2 had position-related OSAS. Patients in the titration failure 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: According to the correlation tests, AHI and the lowest saturation were the two most important predictors of optimal CPAP level.

Keywords

• Obstructive sleep apnea syndrome,Continuous positive airway pressure,apnea,polysomnography

References

1. 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.
2. 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
3. 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
4. 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
5. 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.
6. 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.
7. 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.
8. 9- Stepanski EJ, Dull R, Basner RC. CPAP titration protocols among accredited sleep disorder centers. Sleep Res 1996;25:374.

9. 10- Mokhlesi B, Tulaimat A. Recent advances in obesity hypoventilation syndrome. Chest 2007;132:1322-36.
10. 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.
11. 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.
12. 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.
13. 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.
14. 15- Pevernagie DA, Shepard JW Jr. Relations between sleep stage, posture and effective nasal CPAP levels in OSA. Sleep 1992;15:162-7.
15. 16- Stepanski EJ. The need for a standardized CPAP titration protocol and follow-up procedures. J Clin Sleep Med 2005;1:311.
16. 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.
17. 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.
18. 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.
19. 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.
20. 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.
21. 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.
22. 23- Hoffstein V, Mateika S. Predicting nasal continuous positive airway pressure. Am J Respir Med 1994 150:486–488
23. 24- Oliver Z, Hoffstein V. Predicting effective continuous positive airway pressure. Chest 2000 117:1061–1064
24. 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
25. 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
26. 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
27. 28- Habesoglu MA, Kokturk O. Obstrüktif Uyku Apne Sendromu Tedavisinde CPAP Titrasyon Basıncının Matematiksel Yöntemle Belirlenmesi. Turkiye Klinikleri Arch Lung 2007;8:74-7