Introduction: Only vindication of a nasal continuous positive
airway pressure (CPAP) retitration procedure will be an actual change in the optimal
CPAP pressure after that test. The purpose of this study was to identify any
items in patient characteristics, clinical features, baseline PSG and initial
CPAP titration as predictors of change in optimal pressure on CPAP retitration.
Methods: 46 patients with obstructive sleep apnea (OSA) were
divided in two groups: Group I (optimal pressure was changed on CPAP retitration):
N = 30, M 22 and F 8, age 31-72, BMI 26-50 Kg/m2,
neck size 15 – 20", tonsillectomy in 8, narrow oropharynx in 15,
uvuvlopalatopharyngoplasty (UP3) in 2, abnormal chin in 3, deviated nasal
septum (DNS) and prior nose surgery in 1 each, initial CPAP pressure 6-19 cm, sleep
efficiency 65%-98%, REM latency 0-304 minutes and residual apnea hypopnea index
(AHI) 0-23/hour. Group II (optimal pressure unchanged
after CPAP retitration):
N = 16, M 11 and 5 F, age 32-69, BMI 23-62 Kg/m2,
neck size 14.5-20", tonsillectomy in 6, narrow oropharynx in 5,
abnormal chin in 4, corrective nasal
surgery in 2, DNS in 1, initial CPAP pressure 8-13 cm of H2O, sleep efficiency 69%-95%, REM latency
0-270 minutes and residual AHI 0-19/hour. The
statistical analyses were performed using two-tailed Fisher’s t test and
unpaired t test. A p value of <0.05 was considered statistically
significant. Results: Patient characteristics
(age, gender, neck size, and BMI), clinical features (tonsillar status,
oropharyngeal narrowing, chin abnormality, DNS/nasal surgery or UP3), baseline
PSG or initial CPAP titration (sleep efficiency, REM latency, residual AHI and initial CPAP pressure) did
not differ significantly between the 2 groups (p = 0.09-0.99). Conclusion:
Patient characteristics, clinical features or variables on baseline PSG and
initial CPAP titration do not predict a change in optimal pressure on CPAP retitration.
The results suggest that 1) Significant
weight change; 2) Patient’s subjective feeling of pressure being
too high or insufficient; 3) Residual or recurrent daytime sleepiness
uncorrected by interface readjustments; 4) Post-op
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