Chest
Original Research: Sleep MedicineA Continuous Positive Airway Pressure Trial as a Novel Approach to the Diagnosis of the Obstructive Sleep Apnea Syndrome
Section snippets
Patients
Successive patients referred by primary care physicians to the sleep-disorder center for evaluation of suspected OSA were enrolled if they were habitual snorers, complained of daytime sleepiness, had an Epworth sleepiness scale (ESS) score ≥ 8,1213 and gave informed consent to the study protocol, which was approved by the hospital ethics committee. Exclusion criteria were as follows: a contraindication for CPAP or auto-adjusting CPAP (ie, unstable congestive heart failure, significant lung
Baseline Patient Characteristics
Of 195 successive patients referred for evaluation of sleep apnea, 76 patients (39%, 15 women and 61 men) fulfilled inclusion criteria and participated in the study. Seven patients (4%) refused participation, 10 patients (5%) had to be excluded because of inability to understand German, and 102 patients (52%) had one or several medical exclusion criteria (known sleep disorder or previous CPAP therapy, medical, neurologic or psychiatric disorder explaining some of the symptoms).
The 76 patients
Discussion
We evaluated a novel approach to the diagnosis of patients with clinically suspected OSA. This approach is based on observing the response to a CPAP treatment trial over 2 weeks as the initial diagnostic step rather than on polysomnography, the standard test. The outcome of the CPAP trial was assessed in a simple way by the response to two questions reflecting the benefit perceived by the patients, their propensity to continue treatment, and the objectively measured compliance with CPAP during
References (34)
- et al.
Indications for positive airway pressure treatment of adult obstructive sleep apnea patients
Chest
(1999) - et al.
Comparison of therapeutic and subtherapeutic nasal continuous positive airway pressure for obstructive sleep apnoea: a randomised prospective parallel trial
Lancet
(1999) - et al.
Monitoring carbon dioxide tension and oxygen saturation by a single ear-lobe sensor in patients with critical illness or sleep apnea
Chest
(2005) - et al.
A cause of excessive daytime sleepiness: the upper airway resistance syndrome
Chest
(1993) - et al.
The occurrence of sleep-disordered breathing among middle-aged adults
N Engl J Med
(1993) - et al.
Epidemiology of obstructive sleep apnea: a population health perspective
Am J Respir Crit Care Med
(2002) - et al.
Prospective study of the association between sleep-disordered breathing and hypertension
N Engl J Med
(2000) - et al.
The association between sleep apnea and the risk of traffic accidents. Cooperative Group Burgos-Santander
N Engl J Med
(1999) Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research
Sleep
(1999)Executive summary on the systematic review and practice parameters for portable monitoring in the investigation of suspected sleep apnea in adults
Am J Respir Crit Care Med
(2004)
Access to diagnosis and treatment of patients with suspected sleep apnea
Am J Respir Crit Care Med
Predictors of improvements in daytime function outcomes with CPAP therapy
Am J Respir Crit Care Med
Long-term use of CPAP therapy for sleep apnea/hypopnea syndrome
Am J Respir Crit Care Med
Continuous positive airway pressure for sleep apnoea/hypopnoea syndrome: usefulness of a 2 week trial to identify factors associated with long term use
Thorax
Randomized short-term trial of two autoCPAP devices versus fixed continuous positive airway pressure for the treatment of sleep apnea
Am J Respir Crit Care Med
Randomized placebo-controlled crossover trial of continuous positive airway pressure for mild sleep apnea/hypopnea syndrome
Am J Respir Crit Care Med
Indications and standards for the use of nasal continuous positive airway pressure (CPAP) in sleep apnea syndromes
Am J Respir Crit Care Med
Cited by (46)
Obstructive sleep Apnea detection and alerting system using Piezoelectric sensor array embedded Quilt
2021, Materials Today: ProceedingsPositive Airway Pressure Therapy for Obstructive Sleep Apnea
2016, Otolaryngologic Clinics of North AmericaCitation Excerpt :CPAP and BPAP may be used in an auto-titrating mode, which uses feedback from the patient’s respiratory monitoring to automatically adjust airway pressures.27 Its potential advantages include using it for initial titration of airway pressures in place of PSG in a sleep laboratory28 and to decrease the mean airway pressure, which could improve patient compliance. For autotitrating CPAP, an airway pressure is set.
Risk factors of obstructive sleep apnea among nigerian outpatients
2012, Brazilian Journal of OtorhinolaryngologyCitation Excerpt :Unfortunately many sufferers of OSA are undiagnosed11,12. This is partly because the standard for diagnosis is overnight polysomnography (PSG) which is expensive and not widely available13,14. Also, the attendant discomfort of patients spending the night in sleep laboratories render it rather impracticable for large groups of patients whether as a diagnostic tool or as a screening procedure.
Portable recording in the diagnosis and management of sleep-disordered breathing: Unanswered questions and future research
2011, Sleep Medicine ClinicsCitation Excerpt :Most would agree that patients at no or very low risk for SDB do not need a test, be it PSG or HST, for a disease that they are very likely not to have. In the same vein it could be argued that a patient at very high risk be just started on treatment.23,49 It is the patients in the low-risk and middle-risk categories that are the problem.
Outcomes of home-based diagnosis and treatment of obstructive sleep apnea
2010, ChestCitation Excerpt :In this study, over 75% of subjects preferred level 3 testing over PSG, and 38% of suspected OSA cases met the inclusion criteria, potentially avoiding a PSG. These results are very similar to those of Senn et al,23 who reported that a trial of auto-CPAP had 97% specificity for the diagnosis of OSA and avoided up to 46% of PSGs. Our subject numbers would have likely been higher had we not excluded subjects outside of our health region.
Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).
Unconditional grant support was provided by the Lung Leagues of Zurich and Schaffhausen, Switzerland.