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Volume 14 No. 05
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Scientific Investigations

Prevalence, Associated Clinical Features, and Impact on Continuous Positive Airway Pressure Use of a Low Respiratory Arousal Threshold Among Male United States Veterans With Obstructive Sleep Apnea

Andrey Zinchuk, MD1; Bradley A. Edwards, PhD2,3; Sangchoon Jeon, PhD4; Brian B. Koo, MD5; John Concato, MD1,6; Scott Sands, PhD7; Andrew Wellman, MD, PhD7; Henry K. Yaggi, MD, MPH1
1Department of Medicine, Yale University School of Medicine, New Haven, Connecticut; 2Department of Physiology, Monash University, Melbourne, Victoria, Australia; 3School of Psychological Sciences and Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Melbourne, Victoria, Australia; 4Division of Acute Care/Health Systems, Yale School of Nursing, New Haven, Connecticut; 5Department of Neurology, Yale University, New Haven, Connecticut; 6Clinical Epidemiology Research Center (CERC), VA Connecticut Healthcare System, West Haven, Connecticut; 7Department of Medicine and Department of Neurology, Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts

Study Objectives:

Determine the prevalence of, and clinical features associated with, a low respiratory arousal threshold (ArTH) among patients with obstructive sleep apnea (OSA), and to assess whether a low ArTH is associated with reduced long-term CPAP use.

Methods:

Cross-sectional and longitudinal analyses were performed in an observational study conducted among 940 male Veterans with OSA. Data for clinical characteristics, polysomnography characteristics, and long-term (5 ± 2 years) CPAP use were obtained from clinical records. Logistic regression was used to assess the associations between low ArTH and clinical features, including regular CPAP use.

Results:

A low ArTH was observed in 38% of participants overall, and was more common among nonobese (body mass index < 30 kg/m2) patients (55%).

In adjusted analyses, increasing body mass index (per 5 kg/m2) and antihypertensive medication use were negatively associated with low ArTH, with odds ratio (OR) (95% confidence interval [CI]) of 0.77 (0.69, 0.87) and 0.69 (0.49, 0.98), respectively. Conversely, increasing age (per 10 years) and antidepressant use—OR (95% CI) 1.15 (1.01,1.31) and 1.54 (1.14,1.98), respectively—were positively associated with low ArTH. Nonobese patients with low ArTH were less likely to be regular CPAP users—OR (95% CI) 0.38 (0.20, 0.72)—in an adjusted model.

Conclusions:

Low ArTH is a common trait among Veterans with OSA and is more frequent among those who are older and nonobese and those taking antidepressants, but is less frequent among patients taking antihypertensive medications. A marked reduction of long-term CPAP use in nonobese patients with low ArTH highlights the importance of understanding a patient's physiologic phenotype for OSA management, and suggests potential targets to improve CPAP adherence.

Commentary:

A commentary on this article appears in this issue on page 713.

Citation:

Zinchuk A, Edwards BA, Jeon S, Koo BB, Concato J, Sands S, Wellman A, Yaggi HK. Prevalence, associated clinical features, and impact on continuous positive airway pressure use of a low respiratory arousal threshold among male United States Veterans with obstructive sleep apnea. J Clin Sleep Med. 2018;14(5):809–817.




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