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Escribá J. a, Tenías JM. d, Canet T. b, Hoyo B. c, López E. c, Casaña S. a, Moliner J. a Clinical Neurophysiology Departments of “Doctor Peset” University.

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Presentation on theme: "Escribá J. a, Tenías JM. d, Canet T. b, Hoyo B. c, López E. c, Casaña S. a, Moliner J. a Clinical Neurophysiology Departments of “Doctor Peset” University."— Presentation transcript:

1 Escribá J. a, Tenías JM. d, Canet T. b, Hoyo B. c, López E. c, Casaña S. a, Moliner J. a Clinical Neurophysiology Departments of “Doctor Peset” University Hospital (Valencia) a, “Virgen de los Lirios” Hospital (Alcoi) b, and “Lluis Alcanyís” Hospital (Xàtiva) c. Preventive Medicine Department of “Lluis Alcanyís” Hospital d (Xàtiva)‏ CONCLUSIONS The Miljeteig & Hofstein’s predictive formula does not show a good concordance in our sample. Besides, this method means that up to 33% of the patients need more consultations to readjust the CPAP pressure (5) and it is showed that SAHS patients have better compliance in attended polisomnography titration (6). According to these results, we rather recommend CPAP titration by polisomnography in SAHS patients until more studies would be able to prove if there is another alternative method of titration with enough scientific evidence to replace the polisomnography. References 1.- Akashiba T, Kosaka N, Yamamoto H, Ito D, Saito O, Horie T. Optimal continuous positive airway pressure in patients with obstructive sleep apnoea: role of craniofacial structure. Respir Med 2001;95(5): Lin IF, Chuang ML, Liao YF, Chen NH, Li HY. Predicting effective continuous positive airway pressure in Taiwanese patients with obstructive sleep apnea syndrome. J Formos Med Assoc 2003;102(4): Sforza E, Krieger J, Bacon W, Petiau C, Zamagni M, Boudewijns A. Determinants of effective continuous positive airway pressure in obstructive sleep-apnea. Am J Respir Crit Care Med 1995;151(6): Miljeteig H, Hoffstein V. Determinants of continuous positive airway pressure level for treatment of obstructive sleep apnea. Am Rev Respir Dis. 1991, 47: Masa JF, Jimenez A, Duran J, Capote F, Monasterio C, Mayos M, et al. Alternative methods of titrating continuous positive airway pressure a large multicenter study. Am J Respir Crit Care Med 2004;170(11): Means MK, Edinger JD, Husain AM. CPAP compliance in sleep apnea patients with and without laboratory CPAP titration. Sleep Breath 2004;8:7–14. INTRODUCTION The gold-standard option for Sleep Apnea Hypopnea Syndrome (SAHS) is the CPAP titrated by polisomnography. However, some formulas based on anthropometrics and technical variables have been defined recently in order to try to simplify the treatment. (1-4) For example, Miljeteig & Hofstein designed a predictive formula in 1993 to determine the initial CPAP pressure in SAHS Canadian patients (4) and this method has been widely used in our environment without previous scientific validation.PURPOSE Analyse the unknown concordance between CPAP titration by polisomnography and by the Miljeteig and Hofstein’s predictive formula in a multicenter population in our region. METHODS We analysed 830 patients (mean age 53,3 years, standard deviation: 11,5 years, 85% males) from 3 different hospitals from Region of Valencia (Spain) after a complete data collection and a CPAP pressure estimation by PSG titration and the predictive formula. Our samples were from 2 Secondary Hospitals (Lluis Alcanyis Hospital-Xativa [HLX] and Verge dels Lliris Hospital-Alcoi [HVA]) and 1 Reference Sleep Disorders Hospital (Doctor Peset University Hospital-Valencia [HPV]) Agreement beyond chance between both methods was judged by Lin’s coefficient (Rho). Paired differences were plotted against pair-wise means by Bland-Altman plots. RESULTS The average CPAP titration by polisomnography ranges from 7.4 (HVA) to 10.9 (HLX) cm H20. Descritptive statistics for the three hospitals are shown in Table 1. We found just an slight agreement in HPV (Rho= IC95% a 0.33) and HLX (Rho= 0.19 IC95% 0.14 a 0.24) and a moderate agreement in HVA (Rho= 0.45 IC95% 0.32 a 0.59). Bland-Altman plots showed this poor concordance in the three centers (Figure 1) (2.4) ‏ 8.9 (1.8) ‏ 33.2 (5.2) ‏ 68.9 (26.2) ‏ 43.3 (4.5) ‏ HLX 7.4 (1.6) ‏ 7.1 (1.2) ‏ 31.6 (5.0) ‏ 31.7 (5.0) ‏ 42.9 (3.8) ‏ HVA 7.5 (1.6) ‏ 30.0 (4.1) ‏ 48.7 (25.1) ‏ 42.2 (3.3) ‏ CPAP titration by PSG (cm H2O) ‏ CPAP titration by formula* (cm H2O) ‏ Body Mass Index (Kg/m2) ‏ Apnea/hypopnea index Neck circumference (cm) ‏ HPV Table 1. Descriptive statistics for CPAP titration and independent variables All results expressed as mean (Standard deviation)‏ * CPAP titration = 0,16 x BMI + 0,13 x Neck circumference + 0,04 x Apnea-hipopnea index - 5,12 Figure 1. Bland-Altman plots Hospital de Alcoi [HVA] Hospital Dr Peset [HPV] Hospital de Xàtiva [HLX]


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