A predictive model for optimal continuous positive airway pressure in the treatment of pure moderate to severe obstructive sleep apnea in China

Abstract

Background: Numerous predictive formulas based on different ethnics have been developed to determine continuous positive airway pressure (CPAP) for patients with obstructive sleep apnea (OSA) without laboratory-based manual titrations. However, few studies have focused on patients with OSA in China. Therefore, this study aimed to develop a predictive equation for determining the optimal value of CPAP for patients with OSA in China.

Methods: 526 pure moderate to severe OSA patients with attended CPAP titrations during overnight polysomnogram were spited into either formula derivation (419 patients) or validation (107 patients) group according to the treatment time. Predictive model was created in the derivation group, and the accuracy of the model was tested in the validation group.

Results: Apnea hypopnea index (AHI), body mass index (BMI), longest apnea time (LAT), and minimum percutaneous oxygen saturation (minSpO₂) were considered as independent predictors of optimal CPAP through correlation analysis and multiple stepwise regression analysis. The best equation to predict the optimal value of CPAP was: CPAPpred = 7.581 + 0.020*AHI + 0.101*BMI + 0.015*LAT-0.028*minSpO₂ (R² = 27.2%, p < 0.05).The correlation between predictive CPAP and laboratory-determined manual optimal CPAP was significant in the validation group (r = 0.706, p = 0.000). And the pressure determined by the predictive formula did not significantly differ from the manually titrated pressure in the validation cohort (10 ± 1 cmH₂O vs. 11 ± 3 cmH₂O, p = 0.766).

Conclusions: The predictive formula based on AHI, BMI, LAT, and minSpO₂ is useful in calculating the effective CPAP for patients with pure moderate to severe OSA in China to some extent.

Keywords: Continuous positive airway pressure; Obstructive sleep apnea; Predictive model.