Factors Associated With Residual Apnea-Hypopnea Index Variability During CPAP Treatment

Area of Science:

• Sleep Medicine
• Respiratory Medicine
• Data Science in Healthcare

Background:

• Continuous Positive Airway Pressure (CPAP) is the primary treatment for Obstructive Sleep Apnea (OSA).
• Elevated or variable residual apnea-hypopnea index (rAHI) indicates treatment failure and may signal worsening cardiovascular conditions.
• Prior research links high rAHI and its variability to comorbidities, OSA severity, and CPAP equipment factors.

Purpose of the Study:

• To identify factors associated with different levels of rAHI variability in patients undergoing CPAP treatment.
• To explore the relationship between patient characteristics, comorbidities, and CPAP usage patterns with rAHI variability.

Main Methods:

• A registry-based study analyzed remote monitoring data from 1,126 OSA patients with at least 90 days of CPAP use.
• Hidden Markov models identified distinct groups based on day-to-day rAHI variability trajectories.
• Ordinal logistic regression determined factors associated with higher and more variable rAHI.

Main Results:

• Three rAHI variability groups were identified: low (35%), moderate (37%), and high (28%).
• Factors associated with high rAHI variability included older age, severe OSA at diagnosis, heart failure, opioid/alcohol use, mental health disorders, stroke history, oronasal mask use, and CPAP leaks.
• The study population was middle-aged, predominantly male, and obese.

Conclusions:

• High rAHI variability in CPAP users is associated with a specific set of clinical, lifestyle, and equipment-related factors.
• Recognizing these factors is crucial for developing personalized follow-up strategies and early interventions in OSA management.
• This research highlights the importance of detailed monitoring and analysis for optimizing CPAP therapy effectiveness.