Identifying obstructive sleep apnoea patients responsive to supplemental oxygen therapy

Area of Science:

• Respiratory Medicine
• Sleep Science
• Precision Medicine

Background:

• Obstructive sleep apnoea (OSA) treatment can be personalized by targeting ventilatory instability.
• Supplemental inspired oxygen is a potential precision-medicine approach for selected OSA patients with elevated loop gain.

Purpose of the Study:

• To determine if elevated loop gain and other endophenotypic traits predict the effectiveness of supplemental oxygen in reducing OSA severity.
• To assess if clinical polysomnography can identify OSA patients who will respond to oxygen therapy.

Main Methods:

• A randomized, single-blinded, crossover study involving 36 patients with moderate to severe OSA (apnoea-hypopnoea index >20 events·h⁻¹).
• Patients underwent two overnight polysomnographic studies, one with 40% supplemental oxygen and one with sham air.
• Key OSA endophenotypic traits (loop gain, collapsibility, compensation, arousability) were quantified from polysomnography data.

Main Results:

• Only 25% of patients responded to supplemental oxygen, defined as a ≥50% reduction in apnoea-hypopnoea index.
• Elevated loop gain alone was not a significant predictor of treatment response.
• A post hoc logistic regression model incorporating loop gain, collapsibility, and compensation achieved 83% accuracy in predicting responders, who showed significant AHI reduction, lower blood pressure, and improved sleep quality.

Conclusions:

• Patients whose OSA responds to supplemental oxygen can be identified by measuring endophenotypic traits using diagnostic polysomnography.
• A combination of elevated loop gain, better collapsibility, and compensation can predict oxygen therapy responders.
• This approach supports the use of polysomnography for personalized OSA treatment strategies.