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Kun-Ming Wu, MD; Ching-Chi Lin, MD, FCCP; Chung-Hsin Chiu, MB; Shwu-Fang Liaw, MS
Author and Funding Information

From the Chest Division, Department of Internal Medicine, Department of Medical Research, Mackay Memorial Hospital.

Correspondence to: Ching-Chi Lin, MD, FCCP, Chest Division, Department of Internal Medicine, Mackay Memorial Hospital, 92, Sec 2, Chung Shan N Rd, Taipei, Taiwan; e-mail: cclin@ms2.mmh.org.tw


Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestpubs.org/site/misc/reprints.xhtml).


© 2010 American College of Chest Physicians


Chest. 2010;138(2):463-464. doi:10.1378/chest.10-0872
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To the Editor:

We would like to thank Dr Eliasson for his thoughtful and insightful comments regarding our article in CHEST (February 2010).1 The therapeutic pressure setting for continuous positive airway pressure (CPAP) was determined in the following manner. All patients underwent a standard attended polysomnographic study for CPAP titration with the use of a Sullivan machine (ResMed S8 Escape; Sydney, NSW, Australia) and a comfortably fitted mask. Initial pressure in the mask was set at 4 cm water and was increased overnight by 1-cm water increments based on the presence of apnea, hypopnea, respiratory effort-related arousals, or snoring associated with arousals. We sought to determine the lowest pressure at which most respiratory events were ablated or the point at which a maximum pressure of 15 cm water was reached with the patient in the supine position and in a rapid-eye-movement sleep period.2

All patients were educated regarding obstructive sleep apnea syndrome (OSAS) and the proper use of CPAP. A fixed-pressure CPAP machine was used following the titration. Neither autoadjusting CPAP nor bilevel positive airway pressure was used in this study. The use of CPAP with heated humidification at the effective fixed-pressure mode every night was strongly encouraged, and most patients applied the heated humidification as suggested.

In our study, the correlation between compliance with CPAP use and decrease in inflammatory mediators was not taken into consideration. All of the patients had received recent diagnoses of moderately severe or severe OSAS and were naive to nasal CPAP treatment. They had to tolerate nasal CPAP therapy with two complete 4-week follow-up periods. Their usage diaries indicated that most had a good adherence to nasal CPAP (using CPAP > 4 h/d and > 5 d/wk). For some patients, information on the hours of use per day and percentage of days of use could be obtained when a downloadable data card was inserted into the CPAP machine. For others, the patients self-reported CPAP use during clinic follow-up. Therefore, we have incomplete data to generate the dose-response curve of hours on CPAP vs levels of serum high mobility group box-1 protein.

Wu KM, Lin CC, Chiu CH, Liaw SF. Effect of treatment by nasal continuous positive airway pressure on serum high mobility group box-1 protein in obstructive sleep apnea. Chest. 2010;1372:303-309. [CrossRef] [PubMed]
 
Kushida CA, Chediak A, Berry RB, et al; Positive Airway Pressure Titration Task Force; American Academy of Sleep Medicine Positive Airway Pressure Titration Task Force; American Academy of Sleep Medicine Clinical guidelines for the manual titration of positive airway pressure in patients with obstructive sleep apnea. J Clin Sleep Med. 2008;42:157-171. [PubMed]
 

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References

Wu KM, Lin CC, Chiu CH, Liaw SF. Effect of treatment by nasal continuous positive airway pressure on serum high mobility group box-1 protein in obstructive sleep apnea. Chest. 2010;1372:303-309. [CrossRef] [PubMed]
 
Kushida CA, Chediak A, Berry RB, et al; Positive Airway Pressure Titration Task Force; American Academy of Sleep Medicine Positive Airway Pressure Titration Task Force; American Academy of Sleep Medicine Clinical guidelines for the manual titration of positive airway pressure in patients with obstructive sleep apnea. J Clin Sleep Med. 2008;42:157-171. [PubMed]
 
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