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Does either obesity or OSA severity influence the response of autotitrating CPAP machines in very obese subjects?

  • Sleep Breathing Physiology and Disorders • Original Article
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Abstract

Purpose

The pressures delivered by autotitrating continuous positive airways pressure (CPAP) devices not only treat obstructive sleep apnoea (OSA) effectively but also give potentially interesting physiological information about the forces impinging on the pharynx. In earlier work from this unit, we used correlations between autoCPAP pressure and both OSA severity and obesity, to construct an algorithm to estimate the fixed CPAP pressure a patient required for subsequent clinical use. We wished to discover if these relationships could be reliably extended to a much more obese group.

Methods

We performed a prospective cohort study in an obese population. Measurements of obesity were made, OSA severity was recorded, and the 95th centile autoCPAP pressure was recorded during 1 week of autoCPAP. Spearman’s rank correlation was performed between measurements of obesity and autoCPAP pressure, and between OSA severity and autoCPAP pressure.

Results

Fifty-four obese individuals (median body mass index (BMI) 43.0 kg/m2), 52 % of whom had OSA (apnoea-hypopnoea index (AHI) ≥ 15), had a median 95th centile autoCPAP pressure of 11.8 cmH2O. We found no significant correlation between autoCPAP pressure and neck circumference, waist circumference or BMI. There was a moderate correlation between autoCPAP pressure and OSA severity (AHI r = 0.34, p = 0.02; oxygen desaturation index (ODI) r = 0.48, p < 0.001).

Conclusions

In this population, neither BMI nor neck circumference nor waist circumference is predictive of autoCPAP pressure. Therefore, the previously derived algorithm does not adequately predict the fixed CPAP pressure for subsequent clinical use in these obese individuals. In addition, some subjects without OSA generated high autoCPAP pressures, and thus, the correlation between OSA severity and autoCPAP pressure was only moderate.

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Acknowledgments

This work was supported by the Oxford Health Services Research Committee, the National Institute of Health Research Oxford Biomedical Research Centre and the Oxford Radcliffe Hospital Charitable Funds. We would like to thank the trial nurses Debby Nicoll, Tara Harris and Barbara Winter.

Authors’ contributions

All authors agree to be accountable for all aspects of the work. They have approved this final version. They have been involved in drafting the work and revising it for important intellectual content. AM and JS made substantial contributions to the conception and design of the study. AM was responsible for data acquisition; AM, CT and JS are responsible for the analysis and interpretation.

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Authors and Affiliations

  1. Oxford Centre for Respiratory Medicine and NIHR Oxford Biomedical Research Centre, Churchill Hospital, Oxford University Hospitals NHS Trust, Oxford, OX3 7LJ, UK

    Chris D. Turnbull, Ari R. Manuel & John R. Stradling

Authors
  1. Chris D. Turnbull
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  2. Ari R. Manuel
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  3. John R. Stradling
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Corresponding author

Correspondence to Chris D. Turnbull.

Ethics declarations

Ethical approval

All procedures performed in this study involving human participants were in accordance with the ethical standards of the intuitional and national research committee and with the 1964 Helsinki declaration and its later amendments. The article does not contain any studies with animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Conflict of interest

JS has done consulting work for ResMed UK. AM and CT declare that they have no conflicts of interest.

Additional information

ClinicalTrials.gov, NCT01380418

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Turnbull, C.D., Manuel, A.R. & Stradling, J.R. Does either obesity or OSA severity influence the response of autotitrating CPAP machines in very obese subjects?. Sleep Breath 20, 647–652 (2016). https://doi.org/10.1007/s11325-015-1267-y

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  • DOI: https://doi.org/10.1007/s11325-015-1267-y

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