CPAP Pressure for Prediction of Oral Appliance Treatment Response in Obstructive Sleep Apnea

被引:46
作者
Sutherland, Kate [1 ,2 ]
Phillips, Craig L. [1 ,2 ]
Davies, Amanda [1 ,2 ]
Srinivasan, Vasanth K. [3 ]
Dalci, Oyku [3 ]
Yee, Brendon J. [1 ,4 ]
Darendeliler, M. Ali [3 ]
Grunstein, Ronald R. [1 ,4 ]
Cistulli, Peter A. [1 ,2 ]
机构
[1] Univ Sydney, NHMRC Ctr Sleep Hlth CIRUS, Sydney, NSW 2006, Australia
[2] Royal N Shore Hosp, Dept Resp Med, Ctr Sleep Hlth & Res, Sydney, NSW, Australia
[3] Univ Sydney, Sydney Dent Hosp, Fac Dent, Discipline Orthodont, Sydney, NSW 2006, Australia
[4] Royal Prince Alfred Hosp, Dept Resp & Sleep Med, Sydney, NSW, Australia
来源
JOURNAL OF CLINICAL SLEEP MEDICINE | 2014年 / 10卷 / 09期
关键词
obstructive sleep apnea; oral appliance; continuous positive airway pressure; treatment response; POSITIVE AIRWAY PRESSURE; MANDIBULAR ADVANCEMENT DEVICES; COMPUTATIONAL FLUID-DYNAMICS; CRANIOFACIAL STRUCTURE; THERAPY; EFFICACY; CHINESE; OBESITY; MEN;
D O I
10.5664/jcsm.4020
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Study Objectives: Mandibular advancement splints (MAS) are often preferred to CPAP treatment for OSA but are not always equally efficacious. High therapeutic CPAP pressure has been associated with MAS treatment failure in a Japanese population. We sought to assess the relationship between CPAP pressure and MAS treatment response in an Australian population. Methods: Therapeutic CPAP pressure and MAS treatment response were obtained from a one-month crossover trial of both treatments. Predictive utility of CPAP pressure to identify MAS treatment response was assessed. Results: Seventy-eight OSA patients were included (age 49.3 +/- 11.1 years, BMI 29.1 +/- 5.8 kg/m(2)) with predominantly moderate-severe OSA (AHI 30.0 +/- 12.7/h). CPAP pressure was lower in MAS responders (MAS AHI < 10/h) 9.7 +/- 1.6 vs. 11.7 +/- 2.4 cm H2O, p < 0.01, with area under ROC curve of 0.74 (95% CI 0.63-0.86), p < 0.01. The best cutoff value of 10.5 cm H2O useful for discriminating MAS responders and non-responders in the previous Japanese population, was inadequate for prediction in the current population (0.47 negative predictive value [NPV]). However a cutoff of 13 cm H2O identified MAS non-responders (1.0 NPV). Multivariate regression identified CPAP pressure (odds ratio [95% confidence interval] 0.53 [0.33-0.87], age (0.93 [0.87-0.99]) and AHI (0.92 [0.86-0.97]) as predictors of MAS treatment response (model r(2) = 0.54, p < 0.001). Conclusions: In Australian patients, the majority of whom are Caucasian, a higher therapeutic CPAP pressure requirement in conjunction with age and OSA severity characteristics may be useful to indicate likelihood of success with MAS as an alternative therapy.
引用
收藏
页码:943 / 949
页数:7
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