Heart failure, oronasal CPAP mask, age linked to high residual apnea-hypopnea index

Key takeaways:

• Several clinical and CPAP-related variables were linked to a greater risk for high residual apnea-hypopnea index variability.
• Clinicians should consider these factors when monitoring patients using CPAP.

Patients with obstructive sleep apnea who have heart failure, are of older age or use an oronasal CPAP mask faced an increased risk for high residual apnea-hypopnea index variability, according to results published in CHEST.

CPAP treatment failure is demonstrated through a heightened or variable residual apnea-hypopnea index (rAHI), and this measure may be “triggered by exacerbation of cardiovascular comorbidities,” according to researchers.

“Identifying phenotypic traits and factors associated with high rAHI variability will allow the development of personalized follow-up pathways for CPAP treatment and will help to define appropriate resource allocation for reducing residual events,” Anaïs Rossetto, MS, of Université Grenoble Alpes, and colleagues wrote.

In a retrospective analysis, Rossetto and colleagues evaluated 1,126 patients (median age, 66 years; 70.3% men; median BMI, 30.6 kg/m²) with OSA from a CPAP telemonitoring database and the Multimorbidity Apnea Respiratory Failure Sleep database to see what demographic, clinical and CPAP-related characteristics are linked to high rAHI variability through ordinal logistic regression analysis.

Patients’ CPAP usage had to be remotely monitored for a minimum of 90 days, and these data were used to track daily trajectories of rAHI variability on a hidden Markov model, according to researchers.

Of the total cohort, 985.5 days (interquartile range [IQR], 575.8-1,201.5 days) was the median length of CPAP remote monitoring, during which researchers observed a median rAHI of 1.93 events per hour (IQR, 0.96-3.85 events per hour).

CPAP treatment methods varied within the study population with 52.5% of patients using a nasal mask, followed by 28.2% of patients using an oronasal mask and 7.8% of patients using a nasal pillow mask.

A little less than 30% of patients from this cohort had high rAHI variability (n = 313; 28%), whereas 35% (n = 393) had low rAHI variability and 37% (n = 420) had moderate rAHI variability.

Among those with moderate or high rAHI variability, researchers found several characteristics in multivariate analysis significantly linked to this greater measure:

• heart failure (OR = 2.26; 95% CI, 1.87-2.65);
• use of an oronasal mask (OR = 2.01; 95% CI, 1.56-2.46);
• aged 73 years or older (OR = 1.57; 95% CI, 1.32-1.82);
• mental and behavioral disorders (OR = 1.54; 95% CI, 1.17-1.91);
• opioid intake (OR = 1.49; 95% CI, 1.11-1.87);
• CPAP leaks of 10 L/minute (OR = 1.41; 95% CI, 1.34-1.48);
• alcohol intake (OR = 1.41; 95% CI, 1-1.82);
• transient ischemic attack or stroke (OR = 1.14; 95% CI, 1.1-1.18); and
• increased OSA/AHI severity at diagnosis, 5 events/hour (OR = 1.05; 95% CI, 1.02-1.08).

“Specific clinical contexts or CPAP-related technical settings, such as high BMI, older age, and the use of oronasal masks, require tight and regular monitoring of rAHI because of their association with trajectories of moderate to high rAHI variability,” Rossetto and colleagues wrote. “In the era of personalized management of CPAP therapy, further improvements in telemonitoring algorithms and their prospective validation for routine care may offer the opportunity of early identification of rAHI deterioration, leading to rapid targeted intervention.”