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Evaluation Of Oxygen Desaturation After Autotitrating CPAP Titration FREE TO VIEW

Jeffrey B. Rubins, MD*; Kathleen A. Nelson, RN; Shannon McGaughey, RRT
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Minneapolis VA Medical Center, Minneapolis, MN


Chest


Chest. 2004;126(4_MeetingAbstracts):783S. doi:10.1378/chest.126.4_MeetingAbstracts.783S-a
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Abstract

PURPOSE:  Unmonitored titration of therapeutic continuous positive airway pressure (CPAP) using autotitrating CPAP devices is being used for patients with sleep apnea as a lower cost alternative to formal CPAP titration in a sleep laboratory. However, this strategy cannot detect persistent nocturnal desaturations despite CPAP therapy.

METHODS:  In an attempt to identify predictors of patients who might require supplemental oxygen therapy while on CPAP, we identified 69 patients with significant nocturnal desaturations (defined as oxygen saturation < 90% for >10% of study) out of 483 patients consecutively diagnosed with sleep apnea on unattended cardiopulmonary sleep testing between July 2003 and March 2004.

RESULTS:  Patients with nocturnal desaturations were predominantly male with a mean age of 67, and mean body-mass index of 36.3 (range 26.6 to 61.0). Congestive heart failure was present in 11.6%, and chronic obstructive pulmonary disease in 13%. During cardiopulmonary sleep testing, mean apnea-hypopnea index (AHI) was 40.7 (range 2.6 to 95.4), mean oxygen desaturation index (ODI) was 41.8 (range 1.3 to 101), mean oxygen saturation was 90.1 + 2.7 %, mean nadir oxygen saturation was 70.1 + 12.1 %, and mean percent of study with oxygen saturation < 90% was 34.8 + 21.9 %. Mean therapeutic CPAP pressures were 11.6 + 3.1 cm H2O, with mean AHI on CPAP of 4.35 + 6.84. Of these 69 patients, 13 (18.8%) had persistent significant desaturations when restudied with overnight oximetry while on therapeutic CPAP. Logistic regression analysis showed three variables that were significantly and independently associated with persistent desaturation on CPAP: 1) COPD; 2) the percent of time with oxygen saturation < 90% during cardiopulmonary study; and 3) percent improvement in AHI on CPAP. However, none of the variables evaluated accurately predicted which individual patients would have significant nocturnal desaturations on CPAP therapy.

CONCLUSION:  We therefore caution practitioners to consider overnight oximetry studies for sleep apnea patients with nocturnal desaturations on diagnostic studies who have had unattended CPAP titration.

DISCLOSURE:  J.B. Rubins, None.

Wednesday, October 27, 2004

10:30 AM- 12:00 PM


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