The Baveno Classification as a Predictor of CPAP Titration Pressure in Obstructive Sleep Apnea Syndrome
Abstract
:Highlights
- After retrospective analysis of 427 patients with OSAS, we found a non-significant correlation between the Baveno classification and the CPAP optimum titration pressure.
- We found a strong positive correlation between the optimal CPAP titration and the severity of OSAS, neck circumference, oxygen desaturation index (ODI), mean oxygen saturation, apnea-hypopnea index (AHI), body mass index (BMI), and cumulative sleep time during periods of SpO2 < 90% (T90).
- The Baveno classification does not serve as a useful predictor for determining the optimal CPAP titration pressure.
- A higher CPAP titration pressure is significantly predicted by both the ODI and neck circumference as independent factors.
Abstract
1. Introduction
2. Methods
2.1. The Baveno Classification: [1]
2.2. Statistical Analysis
3. Results
- 101 patients: CPAP therapy was initiated before 2018
- 121 patients: no indication for CPAP therapy
- 49 patients: the ESS was not recorded
- 1 patient: CPAP was titrated outside of the participating institutes
- 1 patient: refused CPAP therapy
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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N (427) | % | |
---|---|---|
Age: years (mean ± SD) | 56.1 ± 11.8 | |
Sex | ||
Males | 341 | 79.9 |
Females | 86 | 29.1 |
BMI (mean ± SD) | 32.8 ± 5.8 | |
Neck circumference (mean ± SD) | 42.8 ± 4.2 | |
ESS median (minimum–maximum) | 11.5 (0–23) | |
Baseline end organ impact | ||
Minor | 219 | 51.4 |
Major | 208 | 48.6 |
Baseline symptoms (n = 417) | ||
Mild | 184 | 44.1 |
Severe | 233 | 55.9 |
Baveno classification (n = 417) | ||
A | 107 | 25.7 |
B | 118 | 28.3 |
C | 74 | 17.7 |
D | 118 | 28.3 |
N (427) | % | |
---|---|---|
Initial polysomnography | ||
AHI median (minimum–maximum) | 37 (6–109) | |
ODI median (minimum–maximum) | 40 (1–128) | |
T90 median (minimum–maximum) | 10 (0–95) | |
Mean SpO2 (mean ± SD) | 90.8 | |
OSAS severity | ||
Mild | 20 | 4.7 |
Moderate | 142 | 33.3 |
Severe | 265 | 62 |
CPAP optimum titration pressure (cmH2O) Median (minimum–maximum); | 8 (4–13) | |
Polysomnography after titration | ||
AHI median (minimum–maximum) | 3 (0–12) | |
ODI median (minimum–maximum) | 6 (0–56) | |
T90 median (minimum–maximum) | 0 (0–23) | |
Mean SpO2 (mean ± SD) | 94.4 ± 1.5 |
Correlation Coefficient * | Significance | |
---|---|---|
Age | −0.03 | 0.4 |
BMI | 0.2 | <0.0001 |
ESS | 0.01 | 0.8 |
Neck circumference | 0.31 | <0.0001 |
T90 | 0.25 | <0.0001 |
AHI | 0.35 | <0.0001 |
ODI | 0.39 | <0.0001 |
Mean SpO2 | −0.2 | <0.0001 |
Baveno classification | 0.01 | 0.7 |
End organ impact | 0.03 | 0.5 |
Symptom severity | 0.04 | 0.4 |
OSAS severity | 0.3 | <0.0001 |
Parameters | Optimum CPAP Pressure < 8 | Optimum CPAP Pressure ≥ 8 | |
---|---|---|---|
Age mean ± SD | 56.1 ± 12.2 | 56.5 ± 11.6 | t: −0.2 p: 0.7 |
Sex (n = 409) | |||
Males | 108 | 218 | X2 0.8 p: 0.3 |
Females | 32 | 51 | |
BMI mean ± SD | 31.1 ± 5.5 | 33.7 ± 5.7 | t: −4.2 p: <0.0001 |
Neck circumference mean ± SD | 41.4 ± 3.9 | 43.4 ± 4.1 | t: −4.7 p: <0.0001 |
Mean SpO2 mean ± SD | 91.3 ± 10.3 | 90.5 ± 9.3 | t: 0.8 p: 0.4 |
AHI median (minimum–maximum) | 29 (6–89) | 41 (6–109) | Z: −4.8 p: <0.0001 |
T90 (minute) median (minimum–maximum) | 6 (0–74) | 12 (0–95) | Z: −3.9 p: <0.0001 |
ODI median (minimum–maximum) | 30 (1–94) | 48 (1–128) | Z: −5.9 p: <0.0001 |
ESS median (minimum–maximum) | 12 (1–23) | 12 (0–23) | Z: −0.1 p: 0.8 |
Symptom severity (n = 399) | |||
Mild | 66 (47.5%) | 109 (41.9%) | X2 1.1 p: 0.3 |
Severe | 73 (52.5%) | 151 (58.1%) | |
End organ impact (n = 408) | |||
Minor | 75 (53.6%) | 136 (50.7%) | X2 0.3 p: 0.5 |
Major | 65 (46.4%) | 132 (49.3%) | |
Baveno classification * | |||
A | 40 | 64 | X2 2.3 p: 0.1 |
B | 32 | 80 | X2 0.02 p: 0.8 |
C | 27 | 41 | X2 0.3 p: 0.5 |
D | 40 | 75 |
Predictors | β | p-Value |
---|---|---|
AHI | 0.08 | 0.3 |
ODI | 0.266 | 0.003 |
T90 | −0.01 | 0.7 |
BMI | 0.05 | 0.3 |
Neck circumference | 0.1 | 0.02 |
Constant = 4.44, adjusted R2 = 0.18, F = 19.1, p = ≤0.001 |
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Ehab, A.; Kempa, A.T.; Englert, H.; Bittar, S.A.; Yousef, A.M.; Abdelwahab, H.W. The Baveno Classification as a Predictor of CPAP Titration Pressure in Obstructive Sleep Apnea Syndrome. Adv. Respir. Med. 2023, 91, 571-579. https://doi.org/10.3390/arm91060042
Ehab A, Kempa AT, Englert H, Bittar SA, Yousef AM, Abdelwahab HW. The Baveno Classification as a Predictor of CPAP Titration Pressure in Obstructive Sleep Apnea Syndrome. Advances in Respiratory Medicine. 2023; 91(6):571-579. https://doi.org/10.3390/arm91060042
Chicago/Turabian StyleEhab, Ahmed, Axel T. Kempa, Harald Englert, Shaza Almasri Bittar, Aida M. Yousef, and Heba Wagih Abdelwahab. 2023. "The Baveno Classification as a Predictor of CPAP Titration Pressure in Obstructive Sleep Apnea Syndrome" Advances in Respiratory Medicine 91, no. 6: 571-579. https://doi.org/10.3390/arm91060042