A Comparison of Different Success Definitions in Non-Continuous Positive Airway Pressure Treatment for Obstructive Sleep Apnea Using Cardiopulmonary Coupling

Authors:
Woo Hyun Lee, Seung-No Hong, Hong Joong Kim, Chae-Seo Rhee, Chul Hee Lee, In-Young Yoon, Jeong-Whun Kim

Reference:
Journal of Clinical Sleep Medicine 2016;12(1):35–41.

Objectives:
The definition and the criteria for the successful treatment of obstructive sleep apnea vary, depending on the study. This study aimed to compare different success criteria of non-continuous positive airway pressure (non-CPAP) treatment for obstructive sleep apnea in terms of sleep quality by using cardiopulmonary coupling.


 

Conclusions:
Cardiopulmonary coupling analysis showed that a reduction in the apnea-hypopnea index of more than 50% might be the optimal criterion to determine the success or failure of non-CPAP treatment in terms of sleep quality.

Practical Significance:
The parameters of cardiopulmonary coupling indicated that sleep quality improved with non-CPAP treatment: low-frequency coupling decreased from 57.4% ± 17.7% to 46.9% ± 16.5%, whereas high-frequency coupling increased from 30.2% ± 17.1% to 37.4% ± 16.7%. In multiple regression analysis, only the criterion of a reduction in the apnea-hypopnea index greater than 50% was significantly associated with sleep quality improvement (p = 0.016; 95% confidence interval, 1.008–1.076 in the high-frequency coupling increment; p = 0.001; 95% confidence interval, 1.025–1.099 in the low-frequency coupling decrement).

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An electrocardiogram-based analysis evaluating sleep quality in patients with obstructive sleep apnea.

Authors:
Harrington J, Schramm PJ, Davies CR, Lee-Chiong TL Jr.

Reference:
Sleep Breath. 2013 Sep;17(3):1071-8.

Objectives:
The study compares polysomnography (PSG) and cardiopulmonary coupling (CPC) sleep quality variables in patients with (1) obstructive sleep apnea (OSA) and (2) successful and unsuccessful continuous positive airway pressure (CPAP) response.

Conclusions:
Tests differentiated no and moderate to severe OSA groups by REM %, HFC, VLFC, and LFC/HFC ratio variables. The successful CPAP therapy group had more HFC, less LFC, and e-LFCBB compared to the unsuccessful CPAP therapy group. HFC ≥ 50 % showed high sensitivity (77.8 %) and specificity (88.9 %) in identifying successful CPAP therapy.

Practical Significance:
The results support the use of the SleepImage system to investigate and objectively measure sleep quality in patients complaining of a sleep disorder.

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Analysis of cardiopulmonary coupling to assess adaptive servo-ventilation success in complex sleep apnea management.

Authors:
Ramar K, Desrues B, Ramar P, Morgenthaler TI.

Reference:
Sleep Breath. 2013 May;17(2):861-6.

Objectives:
ASV success would correlate with elevated proportions of periodic breathing as marked by elevated narrow band low-frequency cardiopulmonary coupling (eNB-LFC) on cardiopulmonary coupling (CPC) analysis.

Conclusions:
ASV brought AHI to 11.0 ± 13.0, with success in 81.1 % of patients, as defined by an AHI of <10/h. NB-LFC was elevated (>0) in 45.3 %; however, the percentage of eNB-LFC did not correlate with ASV treatment success (p = 0.518). No clinical factors were found to be associated with ASV success.

Practical Significance:
ASV was successful in 81 % of patients with CompSAS. However, eNB-LFC calculated from CPC, a marker for periodic breathing, did not correlate with ASV success and therefore may not be a useful tool to predict ASV success.

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Assessment of therapeutic options for mild obstructive sleep apnea using cardiopulmonary coupling measures.

Authors:
Schramm PJ, Thomas RJ

Reference:
J Clin Sleep Med. 2012 Jun 15;8(3):315-20.

Objectives:
To examine the efficacy of various therapeutic modalities for mild obstructive sleep apnea using cardiopulmonary coupling variables of sleep quality.

Conclusions:
Baseline sleep quality estimated using the ratio of high-frequency and low-frequency coupling (1.03) was below the expected normal adult values ranging from 1.67-4.0. The sleep quality ratio was significantly higher (2.08) using the MAA alone compared to baseline, sleep position restriction (1.61), oxygen therapy (0.81), and the combination of MAA with oxygen (1.66).

Practical Significance:
Sleep quality measured objectively using cardiopulmonary coupling variables differentiated the efficacy of therapeutic options for mild obstructive sleep apnea.

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Cardiopulmonary coupling analysis: changes before and after treatment with a mandibular advancement device.

Authors:
Lee WH, Ahn JC, We J, Rhee CS, Lee CH, Yun PY, Yoon IY, Kim JW.

Reference:
Sleep Breath. 2014 Apr 4.

Objectives:
To evaluate the changes of sleep quality in patients using a mandibular advancement device (MAD) for obstructive sleep apnea (OSA) based upon cardiopulmonary coupling (CPC).

Conclusions:
The CPC parameters showed a significant improvement with the use of MAD.

Practical Significance:
CPC parameters of sleep quality was improved by MAD therapy and could be used as a measure of treatment efficacy.

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Sleep quality change after upper airway surgery in obstructive sleep apnea: Electrocardiogram-based cardiopulmonary coupling analysis

Authors:
Choi JH1, Thomas RJ, Suh SY, Park IH, Kim TH, Lee SH, Lee HM, Yun CH, Lee SH.

Reference:
Laryngoscope. 2015 Feb 3. doi: 10.1002/lary.25101.

Objectives:
Sleep quality change after upper airway surgery in obstructive sleep apnea: Electrocardiogram-based cardiopulmonary coupling analysis

Conclusions:
Successful upper airway surgery can improve objective sleep quality in adult patients with OSA. CPC metrics of sleep quality are potentially useful to monitor therapeutic responses during long-term postoperative follow-up, as the ECG-based analysis is available as a standalone option outside laboratory polysomnography.

Practical Significance:
Sleep quality measured by CPC analysis improved significantly (HFC, P = .001; LFC, P = .002; e-LFC, P = .003), along with parallel reduction in ESS, respiratory parameters (AHI, AI, minimum SaO2), and sleep fragmentation (ArI) in the group with surgical success after upper airway surgery.

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The effect of continuous positive airway pressure on cardiopulmonary coupling.

Authors:
Cho, J.H. & Kim, H.J.

Reference:
Sleep Breath. 2017 May;21(2):341-345. doi: 10.1007/s11325-016-1419-8. Epub 2016 Oct 8.

Objectives:
The aim of the study was to investigate cardiopulmonary coupling (CPC) as a tool for evaluating the efficacy of continuous positive airway pressure (CPAP) in the treatment of obstructive sleep apnea (OSA).

Conclusions:
The apnea-hypopnea index, CPC variables, and sleep stage (%) during the first 2 h of the sleep study did not differ between the PSG-only and CPAP titration groups. A comparison of data collected over the first 2 h and that collected over the rest of the sleep study revealed that high-frequency coupling (HFC) increased, and low-frequency coupling (LFC) and elevated LFC (e-LFC) decreased only for the CPAP titration group, while they did not change for the PSG-only group. The proportions of N1 and N3 stages and arousal index decreased while the proportion of R stage increased for both groups. The proportion of N2 stage and mean O2saturation increased only for the CPAP titration group, while they did not change significantly for the PSG-only group. HFC increased while LFC and e-LFC decreased linearly as apnea-hypopnea index decreased for the CPAP titration group.

Practical Significance:
CPC effectively reflects the treatment effect of CPAP when compared with an electroencephalography-based sleep stage assessment.

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