Journal
EUROPEAN RESPIRATORY JOURNAL
Volume 52, Issue 3, Pages -Publisher
EUROPEAN RESPIRATORY SOC JOURNALS LTD
DOI: 10.1183/13993003.00674-2018
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Funding
- American Heart Association [15SDG25890059]
- NIH [R01HL102321, R01HL128658, P01HL094307, P01HL095491, R01HL085188, K24HL132105, T32HL134632, R21HL121794, R01HL119201, R01HL081823]
- National Health and Medical Research Council of Australia [1053201, 1035115, 1064163]
- R. G. Menzies Foundation
- American Thoracic Society Foundation
- Heart Foundation of Australia [101167]
- Harvard Catalyst (National Center for Research Resources)
- Harvard Catalyst (National Center for Advancing Translational Sciences, NIH) [UL1TR001102]
- Crossref Funder Registry
- NATIONAL CENTER FOR ADVANCING TRANSLATIONAL SCIENCES [UL1TR001102] Funding Source: NIH RePORTER
- NATIONAL HEART, LUNG, AND BLOOD INSTITUTE [K24HL132105, R21HL121794, R01HL085188, P01HL095491, R01HL081823, R01HL102321, R01HL119201, P01HL094307, R01HL128658, T32HL134632] Funding Source: NIH RePORTER
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A possible precision-medicine approach to treating obstructive sleep apnoea (OSA) involves targeting ventilatory instability (elevated loop gain) using supplemental inspired oxygen in selected patients. Here we test whether elevated loop gain and three key endophenotypic traits (collapsibility, compensation and arousability), quantified using clinical polysomnography, can predict the effect of supplemental oxygen on OSA severity. 36 patients (apnoea-hypopnoea index (AHI) >20 events.h(-1)) completed two overnight polysomnographic studies (single-blinded randomised-controlled crossover) on supplemental oxygen (40% inspired) versus sham (air). OSA traits were quantified from the air-night polysomnography. Responders were defined by a >= 50% reduction in AHI (supine non-rapid eye movement). Secondary outcomes included blood pressure and self-reported sleep quality. Nine of 36 patients (25%) responded to supplemental oxygen (Delta AHI=72 +/- 5%). Elevated loop gain was not a significant univariate predictor of responder/non-responder status (primary analysis). In post hoc analysis, a logistic regression model based on elevated loop gain and other traits (better collapsibility and compensation; cross-validated) had 83% accuracy (89% before cross-validation); predicted responders exhibited an improvement in OSA severity (Delta AHI 59 +/- 6% versus 12 +/- 7% in predicted non-responders, p=0.0001) plus lowered morning blood pressure and better self-reported sleep. Patients whose OSA responds to supplemental oxygen can be identified by measuring their endophenotypic traits using diagnostic polysomnography.
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