Dataset Information

Multinight recording and analysis of continuous positive airway pressure airflow in the home for titration and management of sleep disordered breathing.

ABSTRACT: The authors examined magnitude/variability of residual sleep disordered breathing (SDB) at pressures around the therapeutic continuous positive airway pressure (CPAP), and described a multinight approach to CPAP titration/retitration consisting of recording airflow and summarizing SDB over multiple nights at multiple pressures and choosing an optimal pressure from these summarized data.Prospective, single-center nonblinded study.Ten female/18 male patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) (respiratory disturbance index [RDI] 67/h), 17 newly-initiated, 11 chronic CPAP users.A custom CPAP device (Fisher & Paykel Healthcare) recording airflow and pre-programmed to vary CPAP between 2-3 cm H2O below and 1-2 cm H2O above prescription pressure as determined by a full laboratory titration.Airflow and pressure continuously recorded for multiple nights (15.9 ± 5.1 nights) at four to seven different pressures in each patient. SDB events manually scored from the airflow as apnea (airflow reduction > 90%), hypopnea (airflow reduction > 30% lasting 10 to 120 sec with inspira-tory flow limitation [IFL]) and runs of sustained IFL > 2 min identified. RDI = (apnea + hypopnea)/total sleep time calculated for each night and an obstruction index, including sustained IFL, also was calculated. PressureMultinight was obtained for each patient from multiple nights of data using two mathematical techniques. Night-to-night variability of SDB indices was low in some patients and significant in others. PressureMultinight could be determined in 17 of 28 patients and was similar to the in-laboratory pressure.This study showed that recording multiple nights of CPAP airflow in the home and analyzing these data for residual SDB provided useful information, including the possibility of determining a therapeutic prescription for fixed CPAP in most patients and identification of others with significant physiologic variability of SDB.

SUBMITTER: Callahan CY

PROVIDER: S-EPMC3595181 | biostudies-other | 2013 Apr

REPOSITORIES: biostudies-other

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Multinight recording and analysis of continuous positive airway pressure airflow in the home for titration and management of sleep disordered breathing.

Callahan Cynthia Y CY Norman Robert G RG Taxin Zachary Z Mooney Anne M AM Rapoport David M DM Ayappa Indu I

Sleep 20130401 4

<h4>Objectives</h4>The authors examined magnitude/variability of residual sleep disordered breathing (SDB) at pressures around the therapeutic continuous positive airway pressure (CPAP), and described a multinight approach to CPAP titration/retitration consisting of recording airflow and summarizing SDB over multiple nights at multiple pressures and choosing an optimal pressure from these summarized data.<h4>Design</h4>Prospective, single-center nonblinded study.<h4>Patients</h4>Ten female/18 ma ...[more]

PMID: 23543909

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Project description:ObjectiveThe role of sleep architecture in consolidation of memory has not been extensively investigated. In this study, the association of continuous positive airway pressure (CPAP) and sleep architecture and quality, and sleep disordered breathing on changes in memory are explored during the course of a 6 month clinical trial of CPAP or sham CPAP (APPLES).Methods848 participants had polysomnographic and memory assessments (Buschke Selective Reminding Test [Buschke] and Digit Symbol Substitution Test [DSST]) at baseline, CPAP/Sham CPAP titration, and the 2 and 6 month time points. Half were assigned to the CPAP and Sham CPAP groups respectively. Changes in performance on the Buschke and the DSST were analyzed over the course of the study between CPAP and Sham CPAP as well as in relationship to changes in sleep architecture, sleep quality and sleep disordered breathing (SDB).ResultsSleep architecture, sleep quality and SDB improved in the CPAP group at 6 months; performance on the Buschke and DSST improved equally in both CPAP and Sham CPAP groups. There also were no significant correlations between changes in the amount or percentage of sleep stages between baseline and the 6 months, and corresponding changes in either the Buschke or the DSST. However, when stratified by the upper quartile and lower 3 quartiles, greater changes in the Buschke occurred over 6 months in the top quartile of total sleep time (5.7±7.3 vs. 4.0±6.8, p≤0.01) and amount of N3 sleep (55.9±7.7 vs. 53.6±8.9 min, p≤0.01). Those with more %N3 at 6 months scored better on the Buschke as well (55.9±7.8 vs. 53.6±8.9, p≤0.01). Borderline improvement in the DSST over 6 months was observed in the top quartiles of amount of N3 and %N3. Those in the top quartile of the amount of REM and %REM also showed greater improvement in the Buschke after 6 months. No differences were observed for the AHI, but those in the top quartile of oxygen desaturation had worse scores on the Buschke at 6 months. CPAP/Sham CPAP adherence did not impact 6 month Buschke or DSST performance.ConclusionsCPAP improved long-term sleep duration, quality and architecture, but did not memory. However, large changes in REM and N3 sleep as well as moderate amounts of nocturnal hypoxemia are associated with changes in assessments of memory.

Dataset Information

Multinight recording and analysis of continuous positive airway pressure airflow in the home for titration and management of sleep disordered breathing.

Publications

Multinight recording and analysis of continuous positive airway pressure airflow in the home for titration and management of sleep disordered breathing.

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