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Eur Respir J. 2018 Sep 27;52(3). pii: 1800674. doi: 10.1183/13993003.00674-2018. Print 2018 Sep.

Identifying obstructive sleep apnoea patients responsive to supplemental oxygen therapy.

Author information

1
Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
2
Dept of Allergy, Immunology and Respiratory Medicine and Central Clinical School, The Alfred and Monash University, Melbourne, Australia.
3
Sleep and Circadian Medicine Laboratory, Dept of Physiology, Monash University, Melbourne, Australia.
4
School of Psychological Sciences, Monash University, Melbourne, Australia.
5
Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Melbourne, Australia.
6
School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Australia.
7
Division of Pulmonary, Critical Care and Sleep Medicine, University of California San Diego, La Jolla, CA, USA.

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.

TRIAL REGISTRATION:

ClinicalTrials.gov NCT01751971.

PMID:
30139771
PMCID:
PMC6232193
DOI:
10.1183/13993003.00674-2018
[Indexed for MEDLINE]
Free PMC Article

Conflict of interest statement

Conflict of interest: S.A. Sands reports grants from NIH and AHA, during the conduct of the study; and personal fees from Cambridge Sound Management, Nox Medical and Merck, outside the submitted work. Conflict of interest: B.A. Edwards received a salary from Heart Foundation of Australia, during the conduct of the study. Conflict of interest: P.I. Terrill reports grants from Australian National Health and Medical Research Council (1064163), during the conduct of the study; and grants from Hull Family Donation, 2014, outside the submitted work. Conflict of interest: J.P. Butler has nothing to disclose. Conflict of interest: R.L. Owens reports personal fees for consultancy from Novartis, and honoraria and travel reimbursement from ResMed and Itamar Medical, outside the submitted work. Conflict of interest: L. Taranto-Montemurro reports grants from American Heart Association, personal fees from Novion Pharmaceuticals and Cambridge Sound management, and other from Apnimed, outside the submitted work. Conflict of interest: A. Azarbarzin has nothing to disclose. Conflict of interest: M. Marques has nothing to disclose. Conflict of interest: L.B. Hess has nothing to disclose. Conflict of interest: E.T. Smales has nothing to disclose. Conflict of interest: C.M. de Melo has nothing to disclose. Conflict of interest: D.P. White reports personal fees from Philips Respironics (Chief Scientific Officer), personal fees for consultancy from Night Balance, and personal fees from Apnicure (previously Chief Medical Officer), outside the submitted work. Conflict of interest: A. Malhotra relinquished all outside personal income in 2012 as an Officer of the American Thoracic Society. ResMed provided a philanthropic donation to University College San Diego in support of a sleep centre. Conflict of interest: A. Wellman reports grants from National Institutes of Health and Philips Respironics, during the conduct of the study; grants from Varnum Sleep and Breathing Solutions and Cambridge Sound Management, and personal fees from Bayer and Nox Medical, outside the submitted work; in addition, A. Wellman has a patent Airway and Airflow Factors issued.

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