A randomized controlled trial of oxygen therapy for patients who do not respond to upper airway surgery for obstructive sleep apnea

Simon A. Joosten, Michael Tan, Ai-Ming Wong, Shane A. Landry, Paul Leong, Scott A. Sands, Caroline Beatty, Luke Thomson, Jeremy Stonehouse, Anthony Turton, Garun S. Hamilton, Bradley A. Edwards

Research output: Contribution to journalArticleResearchpeer-review

Abstract

STUDY OBJECTIVES: We aimed to determine if patients diagnosed with obstructive sleep apnea (OSA) who fail to respond to upper airway surgery may be successfully treated with supplemental oxygen and if we could identify baseline physiological endotypes (i.e. collapsibility, loop gain, arousal threshold and muscle compensation) that predict response to oxygen therapy.
METHODS: We conducted a single night, randomized double blinded cross over trial in which OSA patients who failed to respond to upper airway surgery were treated on separate nights with oxygen therapy (4 L/min) or placebo (medical air). Effect of oxygen/air on OSA on key polysomnography (PSG) outcomes were assessed: apnea-hypopnea index (AHI), AHI without desaturation (i.e. flow-based AHI [AHIfb]), arousal index and morning blood pressure. OSA endotypes were estimated from the PSG signals to determine whether baseline OSA physiology could be used to predict response to oxygen therapy.
RESULTS: There was a statistically significant reduction in AHI and AHIfb on oxygen versus placebo (AHIfb: 42.4±21.5 vs. 30.5±17.1 events/h, p = 0.008). Arousal index was also reduced on oxygen versus placebo (41.1±19.5 versus 33.0±15.3 events/h, p = 0.006). There was no significant difference in morning blood pressure between oxygen and placebo. While 7/20 subjects experienced a 50% reduction or greater in AHIfb on oxygen (responders), there was no difference in the baseline OSA endotypes (or clinical characteristics) between responders and non-responders.
CONCLUSIONS: Our findings demonstrate that a proportion of patients who fail to respond to upper airway surgery for OSA respond acutely to treatment with supplemental oxygen.
CLINICAL TRIAL REGISTRATION: Registry: Australian New Zealand Clinical Trials Registry; title: Oxygen therapy for treating patients with residual obstructive sleep apnoea following upper airway surgery; identifier: ACTRN12617001361392; URL: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=373566
Original languageEnglish
Number of pages18
JournalJournal of Clinical Sleep Medicine
DOIs
Publication statusAccepted/In press - 23 Oct 2020

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