Predictors of treatment outcomes with Auto-titrating CPAP therapy in adults with Obstructive Sleep Apnea

Abstract

AbstractObjectivesTo determine factors that predict OSA therapy outcomes with auto-titrating positive airway pressure (APAP).MethodsWe sequentially grouped patients from a retrospective cohort based on APAP efficacy (sufficiently vs. insufficiently treated; insufficiently treatment defined as residual AHI of ≥ 5); therapy adherence (compliant vs. non-compliant, non-compliance defined as < 70% usage for ≥ 4 hours/night); and therapy outcomes (optimal vs non-optimal (non-optimal outcomes defined as non-compliant and insufficiently treated). We subsequently compared each group.ResultsThe insufficiently treated were older (68.4 ± 12.5 vs. 60.4 ± 13.1 years, p < 0.01) and had lower BMI (31.9 ± 6.3 vs.37.9 ± 9.1 kg/m2, p < 0.01). They had higher baseline central apnea indices (CAI), longer leaks, higher peak pressures and were less compliant.The non-compliant were younger (61.1 ± 12.6 vs. 65.5 ± 13.2 years, p = 0.03) and comprised more females (56.1 vs. 43.9%, p = 0.04). The leak duration per usage hour was higher in the non-compliant (13.9 ± 42.1 vs. 1.83 ± 3.53 minutes/hour, p < 0.01). The non-optimally treated had lower BMI, longer leaks and shorter nightly usage.Following multivariate analysis, the aforementioned variables except age were predictive of higher residual AHI, while age and gender predicted compliance.ConclusionsVarious demographic and clinical factors were predictive of treatment efficacy and adherence. Overall, lower BMI, longer leaks and shorter nightly usage predicted poor therapy outcomes.