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Improved follow-up by peripheral arterial tonometry in CPAP-treated patients with obstructive sleep apnea and persistent excessive daytime sleepiness

  • Sleep Breathing Physiology and Disorders • Original Article
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Abstract

Background

OSA-patients with persistent excessive daytime sleepiness (EDS) despite CPAP treatment are challenging in daily clinical life. To rule out residual sleep-disordered breathing (SDB), CPAP device-derived data are used in outpatient setting. In case of no pathological finding, a more intensive work-up with is necessary. 6-channel portable monitoring (6Ch-PM) is frequently used to exclude residual SDB. Peripheral arterial tonometry (PAT), as embodied in the WatchPAT device, represents an alternative technique for detecting SDB based on changes in autonomic tone. We wanted to investigate whether PAT might be a useful tool to improve diagnostic work-up in this specific patient group by better identifying residual SDB due to insufficient CPAP-adjustment.

Methods

Forty-nine OSA patients (39 male, 10 female) with sufficient CPAP treatment according to device-derived data were consecutively recruited. EDS was assessed by Epworth Sleepiness Scale (ESS). All patients underwent home-based CPAP therapy control by 6Ch-PM and portable monitoring using PAT technology on two consecutive nights. A sequence of both types of monitoring was randomized to prevent possible first night effect bias.

Results

Twelve out of 49 patients showed persistent EDS according to ESS (ESS > 10 points). 6Ch-PM showed a residually increased AHI under CPAP-treatment in 2 of those 12 subjects (positive predictive value, PPV = 16.7%). PAT-PM revealed 5 patients of those 12 with residual SDB (PPV = 41.7%).

Conclusion

PAT could detect significantly more residual SDB under CPAP treatment than 6Ch-PM. Diagnostic work-up of CPAP-treated OSA patients with persistent EDS might be optimized, as insufficient pressure level adjustments could be recognized more precisely in time, possibly preventing more resource-consuming procedures, and potentially increased morbidity.

Clinical trial registration

DRKS00007705

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Funding

Itamar Medical Ltd. (Caesarea, Israel) provided support in the form of funding of the WatchPAT 200 devices and sensors. No compensation had been paid to any staff members or participating patients. The sponsor had no role in the design or performance of this research.

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Authors and Affiliations

  1. Interdiscplinary Center for Sleep Medicine, Charité – Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany

    C. Schöbel, S. Knorre, M. Glos, C. Garcia, I. Fietze & T. Penzel

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  1. C. Schöbel
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  2. S. Knorre
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  3. M. Glos
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  4. C. Garcia
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  5. I. Fietze
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  6. T. Penzel
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Corresponding author

Correspondence to C. Schöbel.

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Conflict of interest

Thomas Penzel has received research grants from ImThera Medical. All other authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee (ethical committee of Charité—Universitätsmedizin Berlin, Germany) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Schöbel, C., Knorre, S., Glos, M. et al. Improved follow-up by peripheral arterial tonometry in CPAP-treated patients with obstructive sleep apnea and persistent excessive daytime sleepiness. Sleep Breath 22, 1153–1160 (2018). https://doi.org/10.1007/s11325-018-1668-9

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  • DOI: https://doi.org/10.1007/s11325-018-1668-9

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