Study on sleep quality of obstructive sleep apnea using cardiopulmonary coupling analysis

Abstract

Background: The aim of this study is (Chapter 1) to evaluate the changes of sleep quality in patients using a mandibular advancement device (MAD) for obstructive sleep apnea (OSA) based upon cardiopulmonary coupling (CPC) and (Chapter 2) to define the success of non-CPAP therapy using CPC analysis in OSA. Materials and methods: (Chapter 1) A total of 52 patients (mean, 53.7 ± 9.6 years

range, 33–74 years) were included in this study. All subjects were diagnosed with OSA after in-laboratory full-night polysomnography (PSG) and reevaluated after 3 month use of a MAD. We compared CPC parameters at baseline with those after 3 month use of a MAD. (Chapter 2) A total of 98 OSA patients (mean 51.6 ± 9.5 years

range 33–74 years) with OSA who treated with sleep surgery or MAD were retrospectively included in this study Results: (Chapter 1) All respiratory indices improved with the use of MAD. However, there were no differences in the sleep architectures except N3 sleep (3.7 ± 4.3 to 6.9 ± 6.4 %, p < 0.001). The CPC parameters showed a significant improvement with the use of MAD. Low frequency coupling (59.5 ± 16.1 to 47.7 ± 14.8 %, p < 0.001) and elevated low frequency coupling (44.6 ± 18.4 to 32.6 ± 15.7 %, p < 0.001) significantly decreased. High frequency coupling (28.6 ± 16.0 to 36.5 ± 15.7 %, p = 0.004) and very low frequency coupling (11.7 ± 7.2 to 15.3 ± 6.6 %, p = 0.028) significantly increased. (Chapter 2) The improvement of sleep quality was significant in the success group which was defined as more than 50% reduction of AHI after treatment. Using this criterion, the best cutoff value for success was at LFCdec = 10.1% with a sensitivity of 66.2 % and a specificity of 66.7 %. Conclusions: (Chapter 1) The CPC parameters showed that the sleep quality was improved by MAD therapy. The CPC analysis may detect a subtle improvement of sleep quality even though patients are unaware of it. (Chapter 2) The criteria of more than 50% reduction of AHI was an optimal criterion to determined successful non CPAP treatment in terms of sleep quality. Using this criterion, the LFCdec ≥ 10.1% cutoff represented clinical value in identifying successful non CPAP therapy.