Korean Journal of Clinical Laboratory Science (대한임상검사과학회지)

Korean Society for Clinical Laboratory Science (대한임상검사과학회)
권호 표지
DOI QR코드

DOI QR Code

Comparison for the Optimal Pressure between Manual CPAP and APAP Titration with Obstructive Sleep Apnea Patients

한국인 폐쇄성 수면 무호흡 환자의 적정 양압을 위한 수동화 양압 측정법과 자동화 양압 측정법의 비교

  • Kim, Dae Jin (Department of Neurology, Pusan National University Yangsan Hospital) ;
  • Choi, Byoung Geol (Research Institute of Health Sciences, Graduate School, Korea University) ;
  • Cho, Jae Wook (Department of Neurology, Pusan National University Yangsan Hospital) ;
  • Mun, Sue Jean (Department of Otorhinolaryngology-Head & Neck Surgery, Pusan National University Yangsan Hospital) ;
  • Lee, Min Woo (Research Institute of Health Sciences, Graduate School, Korea University) ;
  • Kim, Hyun-Woo (Department of Neurology, Pusan National University Yangsan Hospital)
  • 김대진 (부산대학교 양산병원 신경과) ;
  • 최병걸 (고려대학교 보건과학연구소) ;
  • 조재욱 (부산대학교 양산병원 신경과) ;
  • 문수진 (부산대학교 양산병원 이비인후과) ;
  • 이민우 (고려대학교 보건과학연구소) ;
  • 김현우 (부산대학교 양산병원 신경과)
  • Received : 2019.03.28
  • Accepted : 2019.04.08
  • Published : 2019.06.30
Download PDF
⟨ Previous Next ⟩

Abstract

Although auto-adjusting positive airway pressure (APAP) titration at home has several advantages over a CPAP titration in terms of convenience and time saving, there are still concerns as to whether it will show corresponding accuracy when compared to laboratory-based polysomnography (PSG) and CPAP titration. To obtain more evidence supporting home-based auto-titration, APAP titration was performed at home for patients who were presented with OSA on laboratory-based diagnostic PSG followed by CPAP titration. A total of 79 patients were included in the study. They all underwent split-night PSG with CPAP titration, and APAP titration for more than 7 days. The patients with successful titration at both situations were selected. The optimal pressure and apnea-hypopnea index (AHI) of CPAP and APAP titration were compared. The optimal pressure for CPAP and APAP titration were $7.0{\pm}1.8cmH_2O$ and $7.6{\pm}1.6cmH_2O$ (P<0.001), whereas the corresponding AHI were $1.3{\pm}1.5/h$ and $3.0{\pm}1.7/h$ (P<0.001). As a result, the achievement rates of optimal pressure for CPAP and APAP titration were 96.2% and 94.9% (r=-0.045, P=0.688), respectively. The results of this study did not differ with regard to the optimal pressure between CPAP and APAP titration. Overall, CPAP and APAP titrations should be chosen depending on a required situation.

폐쇄성 수면 무호흡 환자들의 양압기 사용을 위한 적정 양압측정은 편리함과 경제성뿐만 아니라 다양한 원인으로 CPAP 측정법보다는 APAP 측정법을 더 선호한다. 그러나 PSG 감시하에 진행하는 CPAP 측정법보다 정확성에 대한 의문이 아직까지 남아있다. 이에 본 연구에서는 동일한 대상자에 대한 CPAP과 APAP 측정법의 적정 압력과 무호흡-저호흡 지수를 변수로서 두 방법간의 효율성과 정확성을 비교하였다. 대상자는 분할 수면다원검사 중 CPAP 양압 측정과 7일 이상 APAP 양압 측정에 성공한 79명이 모집되었다. CPAP과 APAP 측정법의 적정 양압은 $7.0{\pm}1.8cmH_2O$, $7.6{\pm}1.6cmH_2O$ 무호흡-저호흡 지수는 $1.3{\pm}1.5/h$, $3.0{\pm}1.7/h$로 CPAP 측정법이 두 변수 모두 통계적으로 유의하게 낮게 나타났다(P<0.001). 그러나 미국수면학회 가이드라인 무호흡-저호흡 지수 5/h이하의 적정 양압 도달 비율은 CPAP 측정법이 96.2% (76명), APAP 측정법이 94.9% (75명)으로 유의미한 차이를 보이지 않았다(r=-0.045, P=0.688). 본 연구를 요약하면, CPAP은 APAP 측정법보다 좀 더 효율적인 측정법으로 나타났다. 그렇지만 적정 양압에 도달하는 비율은 두 방법 모두 통계적 차이를 나타내지 않아 정확성을 가진다. 따라서 CPAP과 APAP 측정법 중 요구되는 상황에 따라 적절한 방법을 선택하여 적정 양압을 측정할 수 있겠다.

Keywords

References

  1. Nieto FJ, Young TB, Lind BK, Shahar E, Samet JM, Redline S, et al. Association of sleep-disordered breathing, sleep apnea, and hypertension in a large community-based study. Sleep Heart Health Study. JAMA. 2000;283:1829-1836. http://doi.org/10.1001/jama.283.14.1829.
  2. Kim CS. The association between blood pressure and obstructive sleep apnea-hypopnea syndrome. Korean J Clin Lab Sci. 2014;46:106-110. http://doi.org/10.15324/kjcls.2014.46.3.106.
  3. Shahar E, Whitney CW, Redline S, Lee ET, Newman AB, Nieto FJ, et al. Sleep-disordered breathing and cardiovascular disease: cross-sectional results of the Sleep Heart Health Study. Am J Respir Crit Care Med. 2001:163:19-25. http://doi.org/10.1164/ajrccm.163.1.2001008.
  4. Li J, Li MX, Liu SN, Wang JH, Huang M, Wang M, et al. Is brain damage really involved in the pathogenesis of obstructive sleep apnea? Neuroreport. 2014;25:593-595. http://doi.org/10.1097/WNR.0000000000000143.
  5. Engleman HM, Douglas NJ. Sleep. 4: Sleepiness, cognitive function, and quality of life in obstructive sleep apnea/hypopnea syndrome. Thorax. 2004:59:618-622. http://doi.org/10.1136/thx.2003.015867.
  6. Farre R, Hernandez L, Montserrat JM, Rotger M, Ballester E, Navajas D. Sham continuous positive airway pressure for placebo-controlled studies in sleep apnea. Lancet. 1999;353:1154. http://doi.org/10.1016/S0140-6736(99)01056-9.
  7. Engleman HM, Kingshott RN, Wraith PK, Mackay TW, Deary IJ, Douglas NJ. Randomized placebo-controlled crossover trial of continuous positive airway pressure for mild sleep apnea/hypopnea syndrome. Am J Respir Crit Card Med. 1999;159:461-467. http://doi.org/10.1164/ajrccm.159.2.9803121.
  8. Jenkinson C, Davies RJ, Mullins R, Stradling JR. Comparison of therapeutic and subtherapeutic nasal continuous positive airway pressure for obstructive sleep apnea: a randomised prospective parallel trial. Lancet. 1999;353:2100-2105. http://doi.org/10.1016/S0140-6736(98)10532-9.
  9. Kushida CA, Chediak A, Berry RB, Brown LK, Cozal D, Iber C, et al. Clinical guidelines for the manual titration of positive airway pressure in patients with obstructive sleep apnea. J Clin Sleep Med. 2008;4:157-171. https://doi.org/10.5664/jcsm.27133
  10. Rodway GW, Sanders MH. The efficacy of split-night sleep studies. Sleep Med Rev. 2003;7:391-401. http://doi.org/10.1053/smrv.2002.0272.
  11. Berry RB, Sriram P. Auto-adjusting positive airway pressure treatment for sleep apnea diagnosed by home sleep testing. J Clin Sleep Med. 2014;10:1269-1275. http://doi.org/10.5664/jcsm.4272.
  12. McArdle N, Singh B, Murphy M, Gain KR, Maquire C, Mutch S, et al. Continuous positive airway pressure titration for obstructive sleep apnea: automatic versus manual titration. Thorax. 2010;65:606-611. http://doi.org/10.1136/thx.2009.116756.
  13. Shaarawy H, Gharraf H.S. Comparison between the use of APAP and manual titration during split night polysomnography for diagnosis and treatment of OSA. Egypt J Chest Dis Tuberc. 2018;67:175-181. http://doi.org/10.4103/ejcdt.ejcdt_20_18.
  14. American Academy of Sleep Medicine. International classification of sleep disorders (ICSD-3). 3rd ed. Westchester:American Academy of Sleep Medicine; 2014.
  15. Yun CH. A diagnosis and treatment of obstructive sleep apnea syndrome. J Korean Sleep Res Soc. 2014;1:34-40. http://doi.org/10.13078/jksrs.04006.
  16. American Academy of Sleep Medicine Task Force. Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. Sleep. 1999;22:667-689. http://doi.org/10.1093/sleep/22.5.667.
  17. Iber C, Ancoil-Israel S, Chesson AL, Quan SF. The AASM manual for the scoring of sleep and associated event: rules, terminology and technical specifications. Westchester: American Academy of Sleep Medicine; 2007.
  18. Peppard PE, Young T, Palta M, Skatrud J. Prospective study of the association between sleep-disordered breathing and hypertension. N Enqi J Med. 2008;342:1378-1384. http://doi.org/10.1056/NEJM200005113421901.
  19. Punjabi NM, Shahar E, Redline S, Gottlieb DJ, Givelber R, Resnick HE, et al. Sleep-disordered breathing, glucose intolerance, and insulin resistance: the Sleep Heart Health Study. Am J Epidemiol. 2004;160:521-530. http://doi.org/10.1093/aje/kwj261.
  20. Kim DJ, Lee SM, Lee SE, Jeon DS, Kim YS, Lee JK, et al. What do you think about CPAP? : Questionnaire Survey. J Kor Sleep Res. 2010;7:15-21. http://doi.org/10.13078/jksrs.10003.
  21. Loube DI, gay PC, Strohl KP, Pack AI, White DP, Collop NA. Indications for positive airway pressure treatment for adult obstructive sleep apnea patients: a consensus statement. Chest. 1999;115:863-866. http://doi.org/10.1378/chest.115.3.863.
  22. Kushida CA, Littner MR, Morgenthaler T, Alessi CA, Bailey D, Coleman J Jr, et al. Practice parameters for the indications for polysomnography and related procedures: an update for 2005. Sleep. 2005;28:499-521. http://doi.org/10.1093/sleep/28.4.499.
  23. Nicholl DDM, Hanly PJ, Zalucky AA, Mann MC, MacRae JM, Poulin MG, et al. CPAP therapy delays cardiovagal reactivation and decreases arterial renin-angiotensin system activity in humans with obstructive sleep apnea. J Clin Sleep Med. 2018;14:1509-1520. http://doi.org/10.5664/jcsm.7326.
  24. Liquori C, Placidi F, Palmieri MG, Izzi F, Ludovisi R, Mercuri NB, et al. Continuous positive airway pressure treatment may improve optic nerve function in obstructive sleep apnea: an electrophysiological study. J Clin Sleep Med. 2018;14:953-958. http://doi.org/10.5664/jcsm.7158.
  25. Kim DJ, Mun SJ, Choi JS, Lee MW, Cho JW. Case of a change in the polysomnograpy results after using continuous positive airway pressure in a patient with obstructive sleep apnea. Korean J Clin Lab Sci. 2019;51:119-123. http://doi.org/10.15324/kjcls.2019.51.1.119.
  26. McArdle N, Devereux G, Heidarnejad H, Engleman HM, Mackay TW, Douglas NJ. Long-term use of CPAP therapy for sleep apnea/hypopneas syndrome. Am J Respir Crit Care Med. 1999;1595:1108-1114. http://doi.org/10.1164/ajrccm.159.4.9807111.
  27. Kim JH, Kwon MS, Song HM, Lee BJ, Jang YJ, Chung Ys. Compliance with positive airway pressure treatment for obstructive sleep apnea. Clin Exp Otorhinolaryngol. 2009;2: 90-96. http://doi.org/10.3342/ceo.2009.2.2.90.
  28. Stammnitz A, Jerrentrup A, Penzel T, Peter JH, Vogelmeier C, Becker HF. Automatic CPAP titration with different self-setting devices in patients with obstructive sleep apnea. Eur Respir J. 2004;24:273-278. http://doi.org/10.1183/09031936.04.00074304.