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Utility of formulas predicting the optimal nasal continuous positive airway pressure in a Greek population

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Abstract

Background

There have been reports that optimal CPAP pressure can be predicted from a previously derived formula, with the Hoffstein formula being the most accurate and accepted in the literature so far. However, the validation of this predictive model has not been applied in different clinical settings. Our aim was to compare both the Hoffstein prediction formula and a newly derived formula to the CPAP pressure setting assessed during a formal CPAP titration study.

Methods

We prospectively studied 1,111 patients (871 males/240 females) with obstructive sleep apnea hypopnea syndrome (OSAHS) undergoing a CPAP titration procedure. In this large population sample, we tested the Hoffstein formula, utilizing body mass index (BMI), neck circumference and apnea/hypopnea index (AHI), and we compared it with our new formula that included not only AHI and BMI but also smoking history and gender adjustment.

Results

We found that using the Hoffstein prediction formula, successful prediction (predicted CPAP pressure within ±2 cm H2O compared to the finally assessed optimum CPAP pressure during titration) was accomplished in 873 patients (79%), with significant correlation between CPAP predicted pressure (CPAPpred1) and the optimum CPAP pressure (CPAPopt) [r = 0.364, p < 0.001]. With the new formula, including smoking history and gender adjustment, successful prediction was accomplished in 1,057 patients (95%), with significant correlation between CPAP predicted pressure (CPAPpred2) and the CPAPopt (r = 0.392, p < 0.001). However, there was a highly significant correlation between the two formulas (r = 0.918, p < 0.001).

Conclusions

We conclude that the level of CPAP necessary to abolish sleep apnea can be successfully predicted from both equations, using common clinical measurements and prediction formulas that may be useful in calculating the starting pressure for initiating CPAP titration. It may also be possible to shorten CPAP titration and perhaps in selected cases to combine it with the initial diagnostic study.

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Abbreviations

AHI:

Apnea/hypopnea index

BMI:

Body mass index

CPAP:

Continuous positive airway pressure

CPAPopt:

Optimal CPAP

CPAPpred:

Predicted CPAP

ECG:

Electrocardiogram

EEG:

Electroencephalogram

EKG:

Electrocardiogram

EMG:

Electromyogram

EOG:

Electro-oculogram

NC:

Neck circumference

OECD:

Organization for Economic Co-operation and Development

OSAHS:

Obstructive sleep apnea/hypopnea syndrome

PSG:

Polysomnography

SaO2 :

Oxyhemoglobin saturation

WC:

Waist circumference

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Acknowledgments

All authors have contributed to conception and design of the study analysis and interpretation of data, writing the article or revising it critically for important intellectual content and final approval of the version to be published. Dr Tzanakis performed the statistical analysis and interpreted the results. Dr. Schiza and Dr Bouloukaki had full access to all of the data in the study, and take responsibility for the integrity of the data and the accuracy of the data analysis.

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Authors and Affiliations

  1. Sleep Disorders Unit, Department of Thoracic Medicine, University General Hospital, Medical School of the University of Crete, Heraklion, Greece

    Sophia E. Schiza, Izolde Bouloukaki, Violeta Moniaki, Eleni Tzortzaki & Nikolaos M. Siafakas

  2. Sleep disorders Unit, Army General Hospital of Athens, Athens, Greece

    Charalampos Mermigkis & Panagiotis Panagou

  3. Department of Epidemiology, Social Medicine, Medical School of the University of Crete, Heraklion, Greece

    Nikolaos Tzanakis

  4. Thrakis 61A, Brilissia, Athens, Greece

    Charalampos Mermigkis

Authors
  1. Sophia E. Schiza
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  2. Izolde Bouloukaki
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  3. Charalampos Mermigkis
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  6. Violeta Moniaki
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  8. Nikolaos M. Siafakas
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Corresponding author

Correspondence to Charalampos Mermigkis.

Additional information

Sophia E. Schiza and Izolde Bouloukaki contributed equally to this paper.

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Schiza, S.E., Bouloukaki, I., Mermigkis, C. et al. Utility of formulas predicting the optimal nasal continuous positive airway pressure in a Greek population. Sleep Breath 15, 417–423 (2011). https://doi.org/10.1007/s11325-010-0352-5

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  • DOI: https://doi.org/10.1007/s11325-010-0352-5

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