Identifying obstructive sleep apnoea patients responsive to supplemental oxygen therapy

Scott A. Sands, Bradley A. Edwards, Philip I. Terrill, James P. Butler, Robert L. Owens, Luigi Taranto-Montemurro, Ali Azarbarzin, Melania Marques, Lauren B. Hess, Erik T. Smales, Camila M. De Melo, David P White, Atul Malhotra, Andrew Wellman

Research output: Contribution to journalArticleResearchpeer-review

Abstract

A possible precision-medicine approach to treating obstructive sleep apnoea (OSA) involves targeting ventilatory instability (elevated loop gain) using supplemental inspired oxygen in selected patients. Here we test whether elevated loop gain and three key endophenotypic traits (collapsibility, compensation and arousability), quantified using clinical polysomnography, can predict the effect of supplemental oxygen on OSA severity.36 patients (apnoea-hypopnoea index (AHI) >20 events·h-1) completed two overnight polysomnographic studies (single-blinded randomised-controlled crossover) on supplemental oxygen (40% inspired) versus sham (air). OSA traits were quantified from the air-night polysomnography. Responders were defined by a ≥50% reduction in AHI (supine non-rapid eye movement). Secondary outcomes included blood pressure and self-reported sleep quality.Nine of 36 patients (25%) responded to supplemental oxygen (ΔAHI=72±5%). Elevated loop gain was not a significant univariate predictor of responder/non-responder status (primary analysis). In post hoc analysis, a logistic regression model based on elevated loop gain and other traits (better collapsibility and compensation; cross-validated) had 83% accuracy (89% before cross-validation); predicted responders exhibited an improvement in OSA severity (ΔAHI 59±6% versus 12±7% in predicted non-responders, p=0.0001) plus lowered morning blood pressure and "better" self-reported sleep.Patients whose OSA responds to supplemental oxygen can be identified by measuring their endophenotypic traits using diagnostic polysomnography.

Original languageEnglish
Article number1800674
Number of pages12
JournalThe European respiratory journal
Volume52
Issue number3
DOIs
Publication statusPublished - 1 Sep 2018

Cite this

Sands, Scott A. ; Edwards, Bradley A. ; Terrill, Philip I. ; Butler, James P. ; Owens, Robert L. ; Taranto-Montemurro, Luigi ; Azarbarzin, Ali ; Marques, Melania ; Hess, Lauren B. ; Smales, Erik T. ; De Melo, Camila M. ; White, David P ; Malhotra, Atul ; Wellman, Andrew. / Identifying obstructive sleep apnoea patients responsive to supplemental oxygen therapy. In: The European respiratory journal. 2018 ; Vol. 52, No. 3.
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abstract = "A possible precision-medicine approach to treating obstructive sleep apnoea (OSA) involves targeting ventilatory instability (elevated loop gain) using supplemental inspired oxygen in selected patients. Here we test whether elevated loop gain and three key endophenotypic traits (collapsibility, compensation and arousability), quantified using clinical polysomnography, can predict the effect of supplemental oxygen on OSA severity.36 patients (apnoea-hypopnoea index (AHI) >20 events·h-1) completed two overnight polysomnographic studies (single-blinded randomised-controlled crossover) on supplemental oxygen (40{\%} inspired) versus sham (air). OSA traits were quantified from the air-night polysomnography. Responders were defined by a ≥50{\%} reduction in AHI (supine non-rapid eye movement). Secondary outcomes included blood pressure and self-reported sleep quality.Nine of 36 patients (25{\%}) responded to supplemental oxygen (ΔAHI=72±5{\%}). Elevated loop gain was not a significant univariate predictor of responder/non-responder status (primary analysis). In post hoc analysis, a logistic regression model based on elevated loop gain and other traits (better collapsibility and compensation; cross-validated) had 83{\%} accuracy (89{\%} before cross-validation); predicted responders exhibited an improvement in OSA severity (ΔAHI 59±6{\%} versus 12±7{\%} in predicted non-responders, p=0.0001) plus lowered morning blood pressure and {"}better{"} self-reported sleep.Patients whose OSA responds to supplemental oxygen can be identified by measuring their endophenotypic traits using diagnostic polysomnography.",
author = "Sands, {Scott A.} and Edwards, {Bradley A.} and Terrill, {Philip I.} and Butler, {James P.} and Owens, {Robert L.} and Luigi Taranto-Montemurro and Ali Azarbarzin and Melania Marques and Hess, {Lauren B.} and Smales, {Erik T.} and {De Melo}, {Camila M.} and White, {David P} and Atul Malhotra and Andrew Wellman",
year = "2018",
month = "9",
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doi = "10.1183/13993003.00674-2018",
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Sands, SA, Edwards, BA, Terrill, PI, Butler, JP, Owens, RL, Taranto-Montemurro, L, Azarbarzin, A, Marques, M, Hess, LB, Smales, ET, De Melo, CM, White, DP, Malhotra, A & Wellman, A 2018, 'Identifying obstructive sleep apnoea patients responsive to supplemental oxygen therapy' The European respiratory journal, vol. 52, no. 3, 1800674. https://doi.org/10.1183/13993003.00674-2018

Identifying obstructive sleep apnoea patients responsive to supplemental oxygen therapy. / Sands, Scott A.; Edwards, Bradley A.; Terrill, Philip I.; Butler, James P.; Owens, Robert L.; Taranto-Montemurro, Luigi; Azarbarzin, Ali; Marques, Melania; Hess, Lauren B.; Smales, Erik T.; De Melo, Camila M.; White, David P; Malhotra, Atul; Wellman, Andrew.

In: The European respiratory journal, Vol. 52, No. 3, 1800674, 01.09.2018.

Research output: Contribution to journalArticleResearchpeer-review

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T1 - Identifying obstructive sleep apnoea patients responsive to supplemental oxygen therapy

AU - Sands, Scott A.

AU - Edwards, Bradley A.

AU - Terrill, Philip I.

AU - Butler, James P.

AU - Owens, Robert L.

AU - Taranto-Montemurro, Luigi

AU - Azarbarzin, Ali

AU - Marques, Melania

AU - Hess, Lauren B.

AU - Smales, Erik T.

AU - De Melo, Camila M.

AU - White, David P

AU - Malhotra, Atul

AU - Wellman, Andrew

PY - 2018/9/1

Y1 - 2018/9/1

N2 - A possible precision-medicine approach to treating obstructive sleep apnoea (OSA) involves targeting ventilatory instability (elevated loop gain) using supplemental inspired oxygen in selected patients. Here we test whether elevated loop gain and three key endophenotypic traits (collapsibility, compensation and arousability), quantified using clinical polysomnography, can predict the effect of supplemental oxygen on OSA severity.36 patients (apnoea-hypopnoea index (AHI) >20 events·h-1) completed two overnight polysomnographic studies (single-blinded randomised-controlled crossover) on supplemental oxygen (40% inspired) versus sham (air). OSA traits were quantified from the air-night polysomnography. Responders were defined by a ≥50% reduction in AHI (supine non-rapid eye movement). Secondary outcomes included blood pressure and self-reported sleep quality.Nine of 36 patients (25%) responded to supplemental oxygen (ΔAHI=72±5%). Elevated loop gain was not a significant univariate predictor of responder/non-responder status (primary analysis). In post hoc analysis, a logistic regression model based on elevated loop gain and other traits (better collapsibility and compensation; cross-validated) had 83% accuracy (89% before cross-validation); predicted responders exhibited an improvement in OSA severity (ΔAHI 59±6% versus 12±7% in predicted non-responders, p=0.0001) plus lowered morning blood pressure and "better" self-reported sleep.Patients whose OSA responds to supplemental oxygen can be identified by measuring their endophenotypic traits using diagnostic polysomnography.

AB - A possible precision-medicine approach to treating obstructive sleep apnoea (OSA) involves targeting ventilatory instability (elevated loop gain) using supplemental inspired oxygen in selected patients. Here we test whether elevated loop gain and three key endophenotypic traits (collapsibility, compensation and arousability), quantified using clinical polysomnography, can predict the effect of supplemental oxygen on OSA severity.36 patients (apnoea-hypopnoea index (AHI) >20 events·h-1) completed two overnight polysomnographic studies (single-blinded randomised-controlled crossover) on supplemental oxygen (40% inspired) versus sham (air). OSA traits were quantified from the air-night polysomnography. Responders were defined by a ≥50% reduction in AHI (supine non-rapid eye movement). Secondary outcomes included blood pressure and self-reported sleep quality.Nine of 36 patients (25%) responded to supplemental oxygen (ΔAHI=72±5%). Elevated loop gain was not a significant univariate predictor of responder/non-responder status (primary analysis). In post hoc analysis, a logistic regression model based on elevated loop gain and other traits (better collapsibility and compensation; cross-validated) had 83% accuracy (89% before cross-validation); predicted responders exhibited an improvement in OSA severity (ΔAHI 59±6% versus 12±7% in predicted non-responders, p=0.0001) plus lowered morning blood pressure and "better" self-reported sleep.Patients whose OSA responds to supplemental oxygen can be identified by measuring their endophenotypic traits using diagnostic polysomnography.

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DO - 10.1183/13993003.00674-2018

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