The effect of torso elevation on minimum effective continuous positive airway pressure for treatment of obstructive sleep apnea

• Published in: Sleep & breathing Vol. 24; no. 2; pp. 499 - 504
• Main Authors: Riaz, Muhammad, Ravula, Shantan, Obesso, Peter Daniel, Nigam, Gaurav, Baran, Alp Sinan
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01-06-2020; Springer Nature B.V
• Subjects: Adult; Aged; Apnea; Continuous Positive Airway Pressure; Dentistry; Female; Humans; Internal Medicine; Male; Medicine; Medicine & Public Health; Middle Aged; Neurology; Otorhinolaryngology; Pediatrics; Pneumology/Respiratory System; Posture - physiology; Pressure; Respiratory tract; Retrospective Studies; Sleep; Sleep apnea; Sleep Apnea, Obstructive - physiopathology; Sleep Apnea, Obstructive - therapy; Sleep Breathing Physiology and Disorders • Original Article; Sleep disorders; Statistical analysis; Titration; Torso; Treatment Outcome; CPAP titration; Torso elevation; Positive airway pressure; Minimal effective positive airway pressure; Obstructive sleep apnea; Wedge cushion
• ISSN: 1520-9512; 1522-1709
• DOI: 10.1007/s11325-019-01880-w

Background
Continuous positive airway pressure (CPAP) is considered the gold standard treatment of obstructive sleep apnea (OSA). However, it can be a challenge in some patients to find an effective CPAP setting that is well tolerated. A lower CPAP setting may improve patient tolerance of the treatment. The objective of this study was to evaluate the effect of approximately 30° torso elevation on minimum effective CPAP for the treatment of OSA.
Methods
A retrospective chart review was performed to determine the effective CPAP setting required to treat OSA in patients who underwent CPAP titration with torso elevation using a wedge cushion, after having failed during the same titration study to achieve therapeutic results at CPAP of 20 cm H
2
O without torso elevation.
Results
Thirty-nine patients who underwent CPAP titration with and without torso elevation utilizing a wedge cushion had statistically significant lowering of the minimum effective CPAP setting with torso elevation, with a mean CPAP reduction of 4.7 (
p
 < 0.001) compared to ineffective treatment at CPAP of 20 cm H
2
O without torso elevation. Apnea hypopnea index (AHI), respiratory disturbance index (RDI), and lowest oxygen saturation (SpO2) were all improved with torso elevation, with a mean AHI difference of 4.4 (
p
 = 0.03), mean RDI difference of 14.2 (
p
 = 0.001), and mean SpO
2
difference of 5.9% (
p
 = 0.002). Age and BMI were inversely correlated, and gender had no correlation with therapeutic CPAP settings with use of torso elevation.
Conclusion
Torso elevation of approximately 30° resulted in effective CPAP treatment at settings significantly lower than 20 cm H
2
O in all reviewed OSA patients, who had been ineffectively treated without torso elevation at the maximum tested setting of 20 cm H
2
O. This intervention may be a useful adjunct during in-lab titration studies for patients who are not effectively treated at or cannot tolerate high CPAP settings.