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

Abstract

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 H2O 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 H2O 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 SpO2 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 H2O in all reviewed OSA patients, who had been ineffectively treated without torso elevation at the maximum tested setting of 20 cm H2O. 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.

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Abbreviations

CPAP:

continuous positive airway pressure

SpO2:

oxygen saturation

RDI:

respiratory disturbance index

AHI:

apnea hypopnea index

EDS:

excessive daytime sleepiness

SHEP:

shoulder head elevation pillow

Pcrit:

upper airway critical closing pressure

CI:

confidence intervals

OSA:

obstructive sleep apnea

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Acknowledgments

The authors acknowledge Susan Hughes and Dr. Kenneth Guire for assistance with statistical analysis.

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Authors

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MR is the guarantor of the manuscript and takes full responsibility for the integrity of this manuscript, and presented and analyzed the data. AB and MR contributed to the study design, data acquisition, data analysis, data interpretation, drafting of the manuscript, and approval of the final manuscript. GN, SR, and DO contributed to the data acquisition, data analysis, data interpretation, revision of the manuscript, and approval of the final manuscript.

Corresponding author

Correspondence to Alp Sinan Baran.

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The authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional (University of Mississippi Medical Center) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Institutions where worked was performed: University of Mississippi Medical Center, and University of Michigan Health System

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Riaz, M., Ravula, S., Obesso, P.D. et al. The effect of torso elevation on minimum effective continuous positive airway pressure for treatment of obstructive sleep apnea. Sleep Breath 24, 499–504 (2020). https://doi.org/10.1007/s11325-019-01880-w

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Keywords

  • Positive airway pressure
  • Torso elevation
  • Minimal effective positive airway pressure
  • Wedge cushion
  • Obstructive sleep apnea
  • CPAP titration