Purpose

Continuous positive airway pressure (CPAP) is the current gold-standard treatment for moderate to severe obstructive sleep apnea (OSA), and upper airway anatomy plays an increasingly important role in evaluating the efficacy of CPAP therapy. The aim of this observational study was to investigate the influence of upper airway anatomy on CPAP titration in OSA patients assessed by computed tomography (CT) during Müller's maneuver.

Methods

Consecutive patients under investigation for OSA by undergoing polysomnography and CT scan of the upper airway while awake were enrolled. Successful full-night manual titration was performed to determine the optimal CPAP pressure level for OSA patients in supine position using a nasal mask.

Results

A total of 157 subjects (134 males and 23 females) were included. Both apnea–hypopnea index (AHI) and LaSO2 significantly correlated with CPAP titration level, upper airway length (UAL), distance from mandibular plane to hyoid bone (MPH), and neck circumference (all p < 0.05). There were significant positive correlations between CPAP titration level and UAL (r = 0.348, p = 0.000) and MPH (r = 0.313, p = 0.002). Stepwise multiple linear regression analyses were performed to evaluate the independent predictors of AHI, LaSO2, and CPAP titration level. CPAP titration level was identified as an independent explanatory variable for AHI and LaSO2 after adjustment for confounders. Multiple linear regression analyses also indicated that body mass index (BMI) and UAL were independently associated with CPAP titration level (all p < 0.05).

Conclusions

Upper airway abnormalities combined with anthropometric parameters play important roles in CPAP titration for OSA patients, providing additional insight into the factors influencing OSA treatment strategies. UAL and BMI should be taken into consideration when choosing CPAP titration level to improve CPAP compliance.

中文翻译：

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OSA 患者 Müller 操作期间上气道配置对 CT 评估的 CPAP 滴定的影响

目的

持续气道正压通气 (CPAP) 是目前治疗中重度阻塞性睡眠呼吸暂停 (OSA) 的金标准，上气道解剖结构在评估 CPAP 治疗效果方面发挥着越来越重要的作用。这项观察性研究的目的是调查上气道解剖对 OSA 患者在 Müller 操作期间通过计算机断层扫描 (CT) 评估的 CPAP 滴定的影响。

方法

通过在清醒时接受多导睡眠图和上呼吸道 CT 扫描来调查 OSA 的连续患者被纳入研究。使用鼻罩进行了成功的整夜手动滴定以确定 OSA 患者仰卧位的最佳 CPAP 压力水平。

结果

共包括 157 名受试者（134 名男性和 23 名女性）。呼吸暂停低通气指数 (AHI) 和 LaSO2 均与 CPAP 滴定水平、上气道长度 (UAL)、下颌平面到舌骨的距离 (MPH) 和颈围显着相关（所有 p < 0.05）。CPAP 滴定水平与 UAL (r = 0.348, p = 0.000) 和 MPH (r = 0.313, p = 0.002) 之间存在显着正相关。进行逐步多元线性回归分析以评估 AHI、LaSO2 和 CPAP 滴定水平的独立预测因子。在调整混杂因素后，CPAP 滴定水平被确定为 AHI 和 LaSO2 的独立解释变量。多元线性回归分析还表明，体重指数 (BMI) 和 UAL 与 CPAP 滴定水平独立相关（所有 p < 0.05）。

结论

上气道异常结合人体测量参数在 OSA 患者的 CPAP 滴定中发挥重要作用，为影响 OSA 治疗策略的因素提供了额外的见解。在选择 CPAP 滴定水平以提高 CPAP 依从性时，应考虑 UAL 和 BMI。