Oximetry monitoring recommended during PAP initiation for sleep apnea in patients with obesity or nocturnal hypoxemia

V. Koivumäki, P. Maasilta, A. Bachour

Forskningsoutput: TidskriftsbidragArtikelVetenskapligPeer review

Sammanfattning

Study Objectives: No consensus exists regarding monitoring the initiation of positive airway pressure (PAP) by oximetry. A PAP device report may be insufficient to ensure a good therapeutic response in all patients. This study aimed to identify patients who would potentially benefit from oximetry monitoring during PAP initiation. Methods: PAP initiation was routinely monitored at home with an oximeter. Data were reviewed for all patients who underwent PAP initiation in 2015, including a baseline sleep study and PAP initiation data. Group A included patients with an apnea-hypopnea index as determined from the PAP device (AHIPAP) of < 5 events/h and a residual 3% oxygen desaturation index (ODI3) of ≥ 10 events/h. Group B included all remaining patients. Cases with a leak of over 24 L/min or with an oximetry recording time of < 1 hour were excluded. AHIPAP < 5 events/h and residual ODI3 < 10 events/h represented good PAP responses. Results: From 787 patients, 723 were included in this study. Among these, 158 had an AHIPAP of ≥ 5 events/h, whereas 565 had an AHIPAP of < 5 events/h. Group A consisted of 129 patients (18%). The sensitivity of the PAP device indicating a good PAP response reached 93.1%, with a specificity of 37.2%, a negative predictive value of 96.2%, and a positive predictive value of 23.9% using body mass index (BMI) ≥ 30 kg/m2 and baseline SpO2 < 92% as the cutoff points. Conclusions: Relying only on the PAP device parameter to evaluate therapeutic responses provided inconsistent results in one-fifth of cases. Thus, oximetry monitoring during PAP initiation is recommended when baseline SpO2< 92% or when BMI ≥ 30 kg/m2. Otherwise, oximetry monitoring remains optional. © 2018 American Academy of Sleep Medicine. All rights reserved.
Originalspråkengelska
TidskriftJournal of clinical sleep medicine
Volym14
Utgåva11
Sidor (från-till)1859-1863
Antal sidor5
ISSN1550-9389
DOI
StatusPublicerad - 2018
MoE-publikationstypA1 Tidskriftsartikel-refererad

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  • 3121 Inre medicin

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title = "Oximetry monitoring recommended during PAP initiation for sleep apnea in patients with obesity or nocturnal hypoxemia",
abstract = "Study Objectives: No consensus exists regarding monitoring the initiation of positive airway pressure (PAP) by oximetry. A PAP device report may be insufficient to ensure a good therapeutic response in all patients. This study aimed to identify patients who would potentially benefit from oximetry monitoring during PAP initiation. Methods: PAP initiation was routinely monitored at home with an oximeter. Data were reviewed for all patients who underwent PAP initiation in 2015, including a baseline sleep study and PAP initiation data. Group A included patients with an apnea-hypopnea index as determined from the PAP device (AHIPAP) of < 5 events/h and a residual 3{\%} oxygen desaturation index (ODI3) of ≥ 10 events/h. Group B included all remaining patients. Cases with a leak of over 24 L/min or with an oximetry recording time of < 1 hour were excluded. AHIPAP < 5 events/h and residual ODI3 < 10 events/h represented good PAP responses. Results: From 787 patients, 723 were included in this study. Among these, 158 had an AHIPAP of ≥ 5 events/h, whereas 565 had an AHIPAP of < 5 events/h. Group A consisted of 129 patients (18{\%}). The sensitivity of the PAP device indicating a good PAP response reached 93.1{\%}, with a specificity of 37.2{\%}, a negative predictive value of 96.2{\%}, and a positive predictive value of 23.9{\%} using body mass index (BMI) ≥ 30 kg/m2 and baseline SpO2 < 92{\%} as the cutoff points. Conclusions: Relying only on the PAP device parameter to evaluate therapeutic responses provided inconsistent results in one-fifth of cases. Thus, oximetry monitoring during PAP initiation is recommended when baseline SpO2< 92{\%} or when BMI ≥ 30 kg/m2. Otherwise, oximetry monitoring remains optional. {\circledC} 2018 American Academy of Sleep Medicine. All rights reserved.",
keywords = "adult, apnea hypopnea index, Article, body mass, Charlson Comorbidity Index, daytime somnolence, Epworth sleepiness scale, female, human, hypoxemia, major clinical study, male, middle aged, obesity, oximetry, oxygen desaturation, positive end expiratory pressure, predictive value, sleep disordered breathing, treatment response, 3121 Internal medicine",
author = "V. Koivum{\"a}ki and P. Maasilta and A. Bachour",
year = "2018",
doi = "10.5664/jcsm.7480",
language = "English",
volume = "14",
pages = "1859--1863",
journal = "Journal of clinical sleep medicine",
issn = "1550-9389",
publisher = "American Academy of Sleep Medicine",
number = "11",

}

Oximetry monitoring recommended during PAP initiation for sleep apnea in patients with obesity or nocturnal hypoxemia. / Koivumäki, V.; Maasilta, P.; Bachour, A.

I: Journal of clinical sleep medicine , Vol. 14, Nr. 11, 2018, s. 1859-1863.

Forskningsoutput: TidskriftsbidragArtikelVetenskapligPeer review

TY - JOUR

T1 - Oximetry monitoring recommended during PAP initiation for sleep apnea in patients with obesity or nocturnal hypoxemia

AU - Koivumäki, V.

AU - Maasilta, P.

AU - Bachour, A.

PY - 2018

Y1 - 2018

N2 - Study Objectives: No consensus exists regarding monitoring the initiation of positive airway pressure (PAP) by oximetry. A PAP device report may be insufficient to ensure a good therapeutic response in all patients. This study aimed to identify patients who would potentially benefit from oximetry monitoring during PAP initiation. Methods: PAP initiation was routinely monitored at home with an oximeter. Data were reviewed for all patients who underwent PAP initiation in 2015, including a baseline sleep study and PAP initiation data. Group A included patients with an apnea-hypopnea index as determined from the PAP device (AHIPAP) of < 5 events/h and a residual 3% oxygen desaturation index (ODI3) of ≥ 10 events/h. Group B included all remaining patients. Cases with a leak of over 24 L/min or with an oximetry recording time of < 1 hour were excluded. AHIPAP < 5 events/h and residual ODI3 < 10 events/h represented good PAP responses. Results: From 787 patients, 723 were included in this study. Among these, 158 had an AHIPAP of ≥ 5 events/h, whereas 565 had an AHIPAP of < 5 events/h. Group A consisted of 129 patients (18%). The sensitivity of the PAP device indicating a good PAP response reached 93.1%, with a specificity of 37.2%, a negative predictive value of 96.2%, and a positive predictive value of 23.9% using body mass index (BMI) ≥ 30 kg/m2 and baseline SpO2 < 92% as the cutoff points. Conclusions: Relying only on the PAP device parameter to evaluate therapeutic responses provided inconsistent results in one-fifth of cases. Thus, oximetry monitoring during PAP initiation is recommended when baseline SpO2< 92% or when BMI ≥ 30 kg/m2. Otherwise, oximetry monitoring remains optional. © 2018 American Academy of Sleep Medicine. All rights reserved.

AB - Study Objectives: No consensus exists regarding monitoring the initiation of positive airway pressure (PAP) by oximetry. A PAP device report may be insufficient to ensure a good therapeutic response in all patients. This study aimed to identify patients who would potentially benefit from oximetry monitoring during PAP initiation. Methods: PAP initiation was routinely monitored at home with an oximeter. Data were reviewed for all patients who underwent PAP initiation in 2015, including a baseline sleep study and PAP initiation data. Group A included patients with an apnea-hypopnea index as determined from the PAP device (AHIPAP) of < 5 events/h and a residual 3% oxygen desaturation index (ODI3) of ≥ 10 events/h. Group B included all remaining patients. Cases with a leak of over 24 L/min or with an oximetry recording time of < 1 hour were excluded. AHIPAP < 5 events/h and residual ODI3 < 10 events/h represented good PAP responses. Results: From 787 patients, 723 were included in this study. Among these, 158 had an AHIPAP of ≥ 5 events/h, whereas 565 had an AHIPAP of < 5 events/h. Group A consisted of 129 patients (18%). The sensitivity of the PAP device indicating a good PAP response reached 93.1%, with a specificity of 37.2%, a negative predictive value of 96.2%, and a positive predictive value of 23.9% using body mass index (BMI) ≥ 30 kg/m2 and baseline SpO2 < 92% as the cutoff points. Conclusions: Relying only on the PAP device parameter to evaluate therapeutic responses provided inconsistent results in one-fifth of cases. Thus, oximetry monitoring during PAP initiation is recommended when baseline SpO2< 92% or when BMI ≥ 30 kg/m2. Otherwise, oximetry monitoring remains optional. © 2018 American Academy of Sleep Medicine. All rights reserved.

KW - adult

KW - apnea hypopnea index

KW - Article

KW - body mass

KW - Charlson Comorbidity Index

KW - daytime somnolence

KW - Epworth sleepiness scale

KW - female

KW - human

KW - hypoxemia

KW - major clinical study

KW - male

KW - middle aged

KW - obesity

KW - oximetry

KW - oxygen desaturation

KW - positive end expiratory pressure

KW - predictive value

KW - sleep disordered breathing

KW - treatment response

KW - 3121 Internal medicine

U2 - 10.5664/jcsm.7480

DO - 10.5664/jcsm.7480

M3 - Article

VL - 14

SP - 1859

EP - 1863

JO - Journal of clinical sleep medicine

JF - Journal of clinical sleep medicine

SN - 1550-9389

IS - 11

ER -