Source: Annual Congress 2008 - Outcome of adaptive servo ventilation in sleep apnoea
Disease area: Sleep and breathing disorders

Abstract

Rationale: The causes and significance of residual sleep apnea (RSA) on continuous positive airway pressure (CPAP) are unclear. During a randomized trial of ambulatory versus polysomnographic (PSG) titration of CPAP in patients with OSA, we performed PSG on CPAP after 3 months of treatment.
Methods: Patients were randomly assigned to an auto-CPAP based algorithm or standard PSG titration. Outcomes were apnea-hypopnea index (AHI), quality of life (SAQLI), sleepiness (ESS), CPAP pressure and compliance. Data were analysed to determine predictors of RSA (AHI > 10/h). PSGs in patients with RSA were re-scored to assess the accuracy of the original scoring.
Results: Of the 61 patients randomized, 15 (25%) had RSA: 8/31 in the ambulatory, and 7/30 in the PSG group. Baseline age, BMI, ESS, SAQLI, respiratory disturbance index (RDI) and CPAP pressure did not differ between groups and were not predictive of RSA. Predictors of RSA (Relative Risk, 95% CI) were: on-treatment SAQLI < 5.5 (RR 11, 2-79); ESS > 8 (RR 5, 2-11) and CPAP machine derived AHI > 10 (RR 4, 2-9). CPAP compliance was lower in patients with RSA (4.6 vs. 5.7h/night; p = 0.05). Re-scoring of PSGs in patients with RSA revealed no differences in the respiratory events; the majority (65%) were obstructive hypopneas. However central events were present in 86% of patients. Periodic breathing was also common, and in the absence of esophageal pressure measurement was usually scored as obstructive hypopnea.
Conclusion: Despite careful CPAP titration, RSA is common and results in poorer outcomes and CPAP compliance. The high prevalence of central events and periodic breathing suggests that RSA is due to complex sleep apnea rather than inadequate CPAP titration.

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Citations should be made in the following way:
F. Ryan, N. Al Lawati, N. Fox, N. Ayas, P. Hamilton, A. Mulgrew (Vancouver, Canada; Tralee, Ireland). Residual sleep apnea on CPAP: prevalence, predictors and patterns. Eur Respir J 2008; 32: Suppl. 52, 4213

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