Development of new procedure to find an optimal pressure of continuous positive airway pressure therapy for patients with obstructive sleep apnea

概要

[Hypothesis/Aims] Obstructive sleep apnea is most prevalent in all the sleep disorders. It is characterized by the collapse of the upper airway during sleep associated with poor sleep quality and nocturnal hypoxia, leading to long-term detrimental effect on cardiovascular disease and metabolic syndrome. This effect is modifiable by introducing continuous positive airway pressure therapy (CPAP). In order to increase the CPAP efficacy, CPAP titration matters for increasing the adherence to this treatment. Although full-night CPAP titration (fnPT) method has been well established and widely available in the North America, Japan lags behind this technique, because of an insufficient number of sleep technologists who are capable of performing fnPT at night. The aims and hypotheses of this dissertation are to:1)Develop a practical alternative, named the afternoon CPAP titration (aPT). We hypothesize that various clinical parameters including CPAP efficacy and adherence in the two groups do not differ. 2) Test the hypotheses that aPT meets the feasibility under the Japanese clinical setting.

[Methods] We conducted the retrospective study and assessed demographic data and diagnostic polysomnographic parameters, time spent in CPAP titration, CPAP efficacy and long-term adherence of the two groups of our OSA patients who had received CPAP titration either by fnPT (n=46) or by afternoon CPAP titration (aPT, n=22).

[Results/Conclusion] Mean total recording time of aPT was significantly shorter than that by fnPT (p<0.0001). As expected, there was no significant difference in mean residual apnea hypopnea index (AHI) on treatment (fnPT vs. aPT, 3.6±2.5 vs. 3.1±1.2), percent days with device usage (82.5土 16.7 vs. 85.4±17.7%), cumulative device usage hours during the 360 days (1621.2±510.1 vs.1727.1±619.3 hours), average device usage hours per day during 360 days (4.5±1.4 vs. 4.8±1.7 hours), average device usage hours per day during the days of device used of this period (5.4±1.0 vs. 5.5±1.4 hours), and percent of days with device usage >4 hours (66.0±21.8 vs. 68.0±24.4%) during the 360 days after starting CPAP treatment between the two groups. Our study demonstrated that aPT was feasible procedure as an alternative to fnPT.