Predicting CPAP failure in patients with suspected sleep hypoventilation identified on ambulatory testing
© 2020 American Academy of Sleep Medicine..
STUDY OBJECTIVES: Home sleep apnea testing (HSAT) is commonly used to diagnose obstructive sleep apnea, but its role in identifying patients with suspected hypoventilation or predicting their response to continuous positive airway pressure (CPAP) therapy has not been assessed. The primary objective was to determine if HSAT, combined with clinical variables, could predict the failure of CPAP to correct nocturnal hypoxemia during polysomnography in a population with suspected hypoventilation. Secondary objectives were to determine if HSAT and clinical parameters could predict awake or sleep hypoventilation.
METHODS: A retrospective review was performed of 142 consecutive patients who underwent split-night polysomnography for suspected hypoventilation after clinical assessment by a sleep physician and review of HSAT. We collected quantitative indices of nocturnal hypoxemia, patient demographics, medications, pulmonary function tests, as well as arterial blood gas data from the night of the polysomnography . CPAP failure was defined as persistent obstructive sleep apnea, hypoxemia (oxygen saturation measured by pulse oximetry < 85%), or hypercapnia despite maximal CPAP.
RESULTS: Failure of CPAP was predicted by awake oxygen saturation and arterial blood gas results but not by HSAT indices of nocturnal hypoxemia. Awake oxygen saturation ≥ 94% ruled out CPAP failure, and partial pressure of oxygen measured by arterial blood gas ≥ 68 mmHg decreased the likelihood of CPAP failure significantly.
CONCLUSIONS: In patients with suspected hypoventilation based on clinical review and HSAT interpretation by a sleep physician, awake oxygen saturation measured by pulse oximetry and partial pressure of oxygen measured by arterial blood gas can reliably identify patients in whom CPAP is likely to fail. Additional research is required to determine the role of HSAT in the identification and treatment of patients with hypoventilation.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2020 |
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| Erschienen: |
2020 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:16 |
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| Enthalten in: |
Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine - 16(2020), 9 vom: 15. Sept., Seite 1555-1565 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Braganza, Michael V [VerfasserIn] |
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| Links: |
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| Themen: |
Home sleep apnea testing |
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| Anmerkungen: |
Date Completed 23.06.2021 Date Revised 16.09.2021 published: Print Citation Status MEDLINE |
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| doi: |
10.5664/jcsm.8616 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM310807794 |
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| 100 | 1 | |a Braganza, Michael V |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Predicting CPAP failure in patients with suspected sleep hypoventilation identified on ambulatory testing |
| 264 | 1 | |c 2020 | |
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| 500 | |a Date Completed 23.06.2021 | ||
| 500 | |a Date Revised 16.09.2021 | ||
| 500 | |a published: Print | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 2020 American Academy of Sleep Medicine. | ||
| 520 | |a STUDY OBJECTIVES: Home sleep apnea testing (HSAT) is commonly used to diagnose obstructive sleep apnea, but its role in identifying patients with suspected hypoventilation or predicting their response to continuous positive airway pressure (CPAP) therapy has not been assessed. The primary objective was to determine if HSAT, combined with clinical variables, could predict the failure of CPAP to correct nocturnal hypoxemia during polysomnography in a population with suspected hypoventilation. Secondary objectives were to determine if HSAT and clinical parameters could predict awake or sleep hypoventilation | ||
| 520 | |a METHODS: A retrospective review was performed of 142 consecutive patients who underwent split-night polysomnography for suspected hypoventilation after clinical assessment by a sleep physician and review of HSAT. We collected quantitative indices of nocturnal hypoxemia, patient demographics, medications, pulmonary function tests, as well as arterial blood gas data from the night of the polysomnography . CPAP failure was defined as persistent obstructive sleep apnea, hypoxemia (oxygen saturation measured by pulse oximetry < 85%), or hypercapnia despite maximal CPAP | ||
| 520 | |a RESULTS: Failure of CPAP was predicted by awake oxygen saturation and arterial blood gas results but not by HSAT indices of nocturnal hypoxemia. Awake oxygen saturation ≥ 94% ruled out CPAP failure, and partial pressure of oxygen measured by arterial blood gas ≥ 68 mmHg decreased the likelihood of CPAP failure significantly | ||
| 520 | |a CONCLUSIONS: In patients with suspected hypoventilation based on clinical review and HSAT interpretation by a sleep physician, awake oxygen saturation measured by pulse oximetry and partial pressure of oxygen measured by arterial blood gas can reliably identify patients in whom CPAP is likely to fail. Additional research is required to determine the role of HSAT in the identification and treatment of patients with hypoventilation | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 650 | 4 | |a home sleep apnea testing | |
| 650 | 4 | |a hypercapnia | |
| 650 | 4 | |a nocturnal hypoxemia | |
| 650 | 4 | |a obesity hypoventilation syndrome | |
| 650 | 4 | |a respiratory insufficiency | |
| 650 | 4 | |a sleep-disordered breathing | |
| 700 | 1 | |a Hanly, Patrick J |e verfasserin |4 aut | |
| 700 | 1 | |a Fraser, Kristin L |e verfasserin |4 aut | |
| 700 | 1 | |a Tsai, Willis H |e verfasserin |4 aut | |
| 700 | 1 | |a Pendharkar, Sachin R |e verfasserin |4 aut | |
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