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CC BY-NC-ND 4.0 · Sleep Sci 2022; 15(S 02): 328-332
DOI: 10.5935/1984-0063.20210015
ORIGINAL ARTICLE

Average volume-assured pressure support for patients with obstructive sleep apnea with failed CPAP titration

Naomitsu Watanabe
1   University of Maryland School of Medicine, Medicine - Baltimore - Maryland - United States.
,
John M Levri
1   University of Maryland School of Medicine, Medicine - Baltimore - Maryland - United States.
,
Victor T Peng
2   University of Maryland Medical Center Midtown Campus, Medicine - Baltimore - Maryland - United States.
,
Steven M Scharf
1   University of Maryland School of Medicine, Medicine - Baltimore - Maryland - United States.
,
Montserrat Diaz-Abad
1   University of Maryland School of Medicine, Medicine - Baltimore - Maryland - United States.
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ABSTRACT

Objectives: Obstructive sleep apnea (OSA) is a common disease, often treated using continuous positive airway pressure (CPAP) therapy. In many cases, patients fail a CPAP titration study due to inadequate control of the apnea-hypopnea index (AHI, events/hour) or due to treatment-emergent central sleep apnea (TE-CSA). We report our experience using a mode of non-invasive ventilation for alternative treatment of these patients.

Material and Methods: We reviewed records of adults who had OSA with AHI≥15 diagnosed on polysomnography (PSG) with failed CPAP titration and in whom titrations with average volume-assured pressure support (AVAPS) with auto-titrating expiratory positive airway pressure were performed.

Results: Forty-five patients, age 57.9±13.1 y, 26 males, body mass index (BMI) 40.2±8.7kg/m2. Reasons for CPAP titration failure included: TE-CSA (25, 55.6%) and inadequate control of AHI at maximum CPAP of 20cm H2O (20, 44.4%). Changes noted from baseline PSG to AVAPS titration: AHI: 65.3±29.3 decreased to 22.3±16.1 (p<0.001). Median time SpO2 ≤88%: 63.7 to 6.9min (p<0.001). In 16 patients the AHI was reduced to <15 and in 16 additional patients the AHI was reduced to <30. Improvement in AHI was not related to gender, age, or opioid use, but was correlated with BMI: ∆AHI=12.2 - (1.4 * BMI); p=0.05. AVAPS resulted in improved sleep architecture: median N3 sleep increased: 1.4% to 19.6% total sleep time (TST) (p<0.001), and median R sleep increased: 6.4% to 13.6% TST (p<0.01).

Discussion: For patients with OSA for whom CPAP titration failed, titration with AVAPS may be an effective treatment.

Keywords:

Obstructive Sleep Apnea - AVAPS - Therapy - Refractory - CPAP - Noninvasive Ventilation


Publication History

Received: 26 January 2021

Accepted: 19 March 2021

Article published online:
01 December 2023

© 2023. Brazilian Sleep Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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