Outcome of CPAP Titration for Moderate-to-Severe OSA Under Drug-Induced Sleep Endoscopy: A Randomized Controlled Crossover Trial
BackgroundThe titration pressure of continuous positive airway pressure (CPAP) is important in patients with obstructive sleep apnea (OSA). This study aimed to understand the difference between drug-induced sleep endoscopy (DISE)-guided CPAP titration and conventional sleep center (CSC) CPAP titrati...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2022-06-01
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| Series: | Frontiers in Neurology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fneur.2022.882465/full |
| _version_ | 1811247926311124992 |
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| author | Tsai-Yu Wang Tsai-Yu Wang Yu-Chen Huang Ting-Yu Lin Ting-Yu Lin Yung-Lun Ni Yu-Lun Lo Yu-Lun Lo |
| author_facet | Tsai-Yu Wang Tsai-Yu Wang Yu-Chen Huang Ting-Yu Lin Ting-Yu Lin Yung-Lun Ni Yu-Lun Lo Yu-Lun Lo |
| author_sort | Tsai-Yu Wang |
| collection | DOAJ |
| description | BackgroundThe titration pressure of continuous positive airway pressure (CPAP) is important in patients with obstructive sleep apnea (OSA). This study aimed to understand the difference between drug-induced sleep endoscopy (DISE)-guided CPAP titration and conventional sleep center (CSC) CPAP titration in patients with OSA.MethodsIn this randomized, controlled, and single-blind crossover trial, we compared the effects of 1-month CPAP treatment in patients with OSA with either DISE-guided CPAP titration or CSC CPAP titration. Twenty-four patients with OSA were recruited for the study. All patients underwent polysomnography, DISE-guided CPAP titration, and accommodation. Initially, patients were randomly assigned to receive either DISE-guided CPAP titration or CSC CPAP treatment for the first month. They were then switched to other treatments in the second month. The Epworth sleepiness scale (ESS) score was recorded at baseline, 1 and 2 months.ResultsThe upper limit of the pressure of DISE-guided titration and CSC CPAP titration was not significantly different (13.9 ± 0.7 vs. 13.5 ± 0.5 cm H2O; P = 0.92). The residual apnea-hypopnea index and compliance were also not significantly different between the groups. ESS score significantly improved from baseline to 1 month after CPAP treatment in both groups. Both epiglottis (anterior-posterior collapse) and tongue base collapse were significantly associated with 95% CPAP pressure (P = 0.031 and 0.038, respectively). After multivariate regression analyses, the epiglottis (anterior-posterior collapse) was an independent factor for 95% CPAP pressure. The incidence rate of bradycardia was 58.3%, which is a safety concern for DISE. Despite the high incidence of bradycardia, all patients with bradycardia recovered with proper management.ConclusionBoth modalities were comparable in terms of establishing the pressure settings required to treat patients. Further large-scale studies are required to confirm these results.Trial registrationhttps://clinicaltrials.gov/, NCT03523013. |
| first_indexed | 2024-04-12T15:19:08Z |
| format | Article |
| id | doaj.art-08fa7b6879ee4bb5a2f10bdd89fb181b |
| institution | Directory Open Access Journal |
| issn | 1664-2295 |
| language | English |
| last_indexed | 2024-04-12T15:19:08Z |
| publishDate | 2022-06-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Neurology |
| spelling | doaj.art-08fa7b6879ee4bb5a2f10bdd89fb181b2022-12-22T03:27:32ZengFrontiers Media S.A.Frontiers in Neurology1664-22952022-06-011310.3389/fneur.2022.882465882465Outcome of CPAP Titration for Moderate-to-Severe OSA Under Drug-Induced Sleep Endoscopy: A Randomized Controlled Crossover TrialTsai-Yu Wang0Tsai-Yu Wang1Yu-Chen Huang2Ting-Yu Lin3Ting-Yu Lin4Yung-Lun Ni5Yu-Lun Lo6Yu-Lun Lo7Department of Thoracic Medicine, Chang Gung Memorial Hospital Linkou Main Branch, Taoyuan, TaiwanSchool of Medicine, Chang Gung University, Taoyuan, TaiwanDepartment of Thoracic Medicine, Chang Gung Memorial Hospital Linkou Main Branch, Taoyuan, TaiwanDepartment of Thoracic Medicine, Chang Gung Memorial Hospital Linkou Main Branch, Taoyuan, TaiwanSchool of Medicine, Chang Gung University, Taoyuan, TaiwanDepartment of Chest Medicine, Buddhist Tzu Chi General Hospital, Taichung Branch, Taichung, TaiwanDepartment of Thoracic Medicine, Chang Gung Memorial Hospital Linkou Main Branch, Taoyuan, TaiwanSchool of Medicine, Chang Gung University, Taoyuan, TaiwanBackgroundThe titration pressure of continuous positive airway pressure (CPAP) is important in patients with obstructive sleep apnea (OSA). This study aimed to understand the difference between drug-induced sleep endoscopy (DISE)-guided CPAP titration and conventional sleep center (CSC) CPAP titration in patients with OSA.MethodsIn this randomized, controlled, and single-blind crossover trial, we compared the effects of 1-month CPAP treatment in patients with OSA with either DISE-guided CPAP titration or CSC CPAP titration. Twenty-four patients with OSA were recruited for the study. All patients underwent polysomnography, DISE-guided CPAP titration, and accommodation. Initially, patients were randomly assigned to receive either DISE-guided CPAP titration or CSC CPAP treatment for the first month. They were then switched to other treatments in the second month. The Epworth sleepiness scale (ESS) score was recorded at baseline, 1 and 2 months.ResultsThe upper limit of the pressure of DISE-guided titration and CSC CPAP titration was not significantly different (13.9 ± 0.7 vs. 13.5 ± 0.5 cm H2O; P = 0.92). The residual apnea-hypopnea index and compliance were also not significantly different between the groups. ESS score significantly improved from baseline to 1 month after CPAP treatment in both groups. Both epiglottis (anterior-posterior collapse) and tongue base collapse were significantly associated with 95% CPAP pressure (P = 0.031 and 0.038, respectively). After multivariate regression analyses, the epiglottis (anterior-posterior collapse) was an independent factor for 95% CPAP pressure. The incidence rate of bradycardia was 58.3%, which is a safety concern for DISE. Despite the high incidence of bradycardia, all patients with bradycardia recovered with proper management.ConclusionBoth modalities were comparable in terms of establishing the pressure settings required to treat patients. Further large-scale studies are required to confirm these results.Trial registrationhttps://clinicaltrials.gov/, NCT03523013.https://www.frontiersin.org/articles/10.3389/fneur.2022.882465/fullCPAPOSAoutcomeCPAP pressuredrug-induced sleep endoscopy (DISE) |
| spellingShingle | Tsai-Yu Wang Tsai-Yu Wang Yu-Chen Huang Ting-Yu Lin Ting-Yu Lin Yung-Lun Ni Yu-Lun Lo Yu-Lun Lo Outcome of CPAP Titration for Moderate-to-Severe OSA Under Drug-Induced Sleep Endoscopy: A Randomized Controlled Crossover Trial Frontiers in Neurology CPAP OSA outcome CPAP pressure drug-induced sleep endoscopy (DISE) |
| title | Outcome of CPAP Titration for Moderate-to-Severe OSA Under Drug-Induced Sleep Endoscopy: A Randomized Controlled Crossover Trial |
| title_full | Outcome of CPAP Titration for Moderate-to-Severe OSA Under Drug-Induced Sleep Endoscopy: A Randomized Controlled Crossover Trial |
| title_fullStr | Outcome of CPAP Titration for Moderate-to-Severe OSA Under Drug-Induced Sleep Endoscopy: A Randomized Controlled Crossover Trial |
| title_full_unstemmed | Outcome of CPAP Titration for Moderate-to-Severe OSA Under Drug-Induced Sleep Endoscopy: A Randomized Controlled Crossover Trial |
| title_short | Outcome of CPAP Titration for Moderate-to-Severe OSA Under Drug-Induced Sleep Endoscopy: A Randomized Controlled Crossover Trial |
| title_sort | outcome of cpap titration for moderate to severe osa under drug induced sleep endoscopy a randomized controlled crossover trial |
| topic | CPAP OSA outcome CPAP pressure drug-induced sleep endoscopy (DISE) |
| url | https://www.frontiersin.org/articles/10.3389/fneur.2022.882465/full |
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