Obstructive sleep apnoea (OSA) is a highly prevalent sleep disorder with serious cardiovascular and neurocognitive consequences. Continuous positive airway pressure (CPAP) is the current gold standard treatment for OSA. While highly efficacious, CPAP is poorly tolerated by many individuals, and for those that cannot tolerate this treatment clinicians must consider alternative treatments.
While there is a growing range of alternative non-CPAP therapies for OSA (such as mandibular advancement splints, weight loss, surgery, supplemental oxygen or hypnotics, etc.) these therapies can be highly variable in their treatment efficacy. Currently, it is difficult for clinicians to know which therapies will work for a particular patient.
The physiology responsible for OSA differs from patient to patient. Recent work suggests that measuring
this physiology in an individual patient may help us to determine whether they will respond to certain treatment options. Unfortunately, current methods for measuring OSA physiology are technically difficult and require specialised laboratory equipment. Simpler ways of measuring this physiology are required in order for this information to be accessible in clinical practice.
In the present study, we compared the utility of different measures upper airway collapsibility to predict their therapeutic response to the combination of oxygen and a hypnotic for the treatment of obstructive sleep apnoea (OSA).
We found that a lower therapeutic CPAP requirement, as a surrogate measure of milder airway collapsibility, predicted a stronger response to this particular therapeutic combination. Most importantly, our findings suggest that a patient’s CPAP requirement is equally predictive as other validated physiological measurements of upper airway collapsibility such as the passive pharyngeal critical closing pressure (Pcrit) and ventilation at CPAP level of 0 cmH2O (Vpassive).
The key implication of this finding is that useful information relevant to the likelihood of treatment response can be determined from routine clinical information, without requiring specialized laboratory assessments.
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This publication was accompanied by the editorial:
Grunstein, R. R. (2017). "Will the safe-breakers of sleep apnoea find the right combination?" Respirology.
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