Clinical, polysomnographic, and CPAP titration features of obstructive sleep apnea: Mixed versus purely obstructive type

Jun 13, 2015Journal of the neurological sciences

Sleep study and treatment differences between mixed and purely obstructive sleep apnea

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Abstract

Mixed sleep apnea patients exhibited a higher apnea-hypopnea index compared to pure obstructive sleep apnea patients.

Mixed-OSA patients had a greater proportion of males and higher body mass index than those with pure-OSA.
Higher daytime sleepiness scores were observed in the mixed-OSA group.
Older age, male sex, and higher body mass index were independently linked to mixed-OSA prior to the sleep study.
The mixed-OSA group showed a higher occurrence of complex sleep apnea and less optimal CPAP titration.
Patients in the mixed-OSA group required higher CPAP pressures than those in the pure-OSA group.

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PURPOSE: To determine whether obstructive sleep apnea syndrome (OSAS) patients with mixed sleep apnea (MSA) have different clinical, polysomnographic, and continuous positive airway pressure (CPAP) titration findings compared to OSAS patients without MSA.

METHODS: We retrospectively reviewed the records of OSAS patients who had undergone CPAP titration and categorized them into pure-OSA and mixed-OSA groups. Demographic features, daytime sleepiness, and apnea severity were compared between the two groups using univariate and multivariate analyses. CPAP titration findings were also compared between the two groups.

RESULTS: One hundred and ninety-five subjects (n=126 pure-OSA; n=69 mixed-OSA) were included in the analysis. Compared to the pure-OSA group, the mixed-OSA group had a higher percentage of males (p=0.003) and a higher body mass index (p=0.044), Epworth Sleepiness Scale score (p=0.028), and apnea-hypopnea index (AHI) (p<0.001). In logistic regression analysis, older age, male sex, and higher body mass index were independently associated with mixed-OSA before PSG study. When using AHI as a covariable, the higher AHI with older age, male sex, and daytime sleepiness was independently related to mixed-OSA. The mixed-OSA group had a higher percentage of patients with complex sleep apnea, a lower percentage of patients with optimal titration, and a higher titrated pressure than the pure-OSA group.

CONCLUSIONS: Severe OSA, older age, male sex, obesity, and daytime sleepiness were related to mixed-OSA. Complex sleep apnea, less optimal titration, and a higher titrated CPAP were also associated with MSA in OSAS patients.

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Clinical, polysomnographic, and CPAP titration features of obstructive sleep apnea: Mixed versus purely obstructive type

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