Residual sleep apnea on polysomnography after 3 months of CPAP therapy: clinical implications, predictors and patterns.
OBJECTIVE
We sought to determine the clinical implications, predictors and patterns of residual sleep apnea on continuous positive airway pressure (CPAP) treatment in patients with moderate-to-severe obstructive sleep apnea (OSA).


METHODS
We performed a post hoc secondary analysis of data from a previously reported randomized trial. Sleepy patients with a high risk of moderate-to-severe OSA identified by a diagnostic algorithm were randomly assigned to standard CPAP titration during polysomnography (PSG) or ambulatory titration using auto-CPAP and home sleep testing. We observed them for 3 months and measured apnea-hypopnea index (AHI) on CPAP, Epworth sleepiness scale (ESS), sleep apnea quality of life index (SAQLI), CPAP pressure and objective CPAP compliance.


RESULTS
Sixty-one patients were randomized, 30 to the PSG group and 31 to the ambulatory group. Fifteen patients (25%) had residual sleep apnea (AHI > 10/h on CPAP) with similar proportions in the PSG (7/30) and ambulatory (8/31) groups. Baseline variables including age, body mass index (BMI), ESS, SAQLI, respiratory disturbance index (RDI) and CPAP pressure did not differ between the groups. Outcomes including compliance were worse in patients with residual sleep apnea. Periodic breathing was prevalent among patients with residual sleep apnea.


CONCLUSIONS
Residual sleep apnea is common in patients with moderate-to-severe OSA, despite careful CPAP titration, and is associated with worse outcomes.
Mulgrew
Alan T
AT
Department of Medicine, Bon Secours Hospital, Tralee, Co. Kerry, Ireland.
Lawati
Nabil Al
NA
Ayas
Najib T
NT
Fox
Nurit
N
Hamilton
Peter
P
Cortes
Lisa
L
Ryan
C Frank
CF
D045422:Continuous Positive Airway Pressure; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017286:Polysomnography; D011788:Quality of Life; D012372:ROC Curve; D012119:Respiration; D012720:Severity of Illness Index; D012890:Sleep / Q000502:physiology; D020181:Sleep Apnea, Obstructive / Q000503:physiopathology / Q000628:therapy*; D012894:Sleep Stages / Q000502:physiology; D018709:Statistics, Nonparametric; D017211:Treatment Failure; D016896:Treatment Outcome