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Predictive tools for nocturnal respiratory failure in patients with moderate and severe OSAS

  • Sleep Breathing Physiology and Disorders • Original Article
  • Published:
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Abstract

Purpose

The impact of obstructive sleep apnea syndrome (OSAS) in terms of mortality, morbidity, and quality of life has been well established. Phenotyping OSAS is essential in order to make the best therapeutic choice. A particular subset of patients with OSAS shows nocturnal respiratory failure, defined by a nighttime oxygen saturation <90% in more than 30% of the total sleep time (TST90). The aim of this study was to identify possible predictive factors for nighttime respiratory failure (NRF) in patients with OSAS.

Methods

In this retrospective study, patients with suspected OSAS who underwent a sleep study were enrolled. Of 116 patients with moderate/severe OSAS who met the inclusion criteria, 67 also had nocturnal respiratory failure. We compared clinical, anthropometric, and laboratory data in patients with OSAS vs. OSAS and nocturnal respiratory failure.

Results

Patients with OSAS and nocturnal respiratory failure were more frequently female, had a higher BMI, lower daytime oxygen partial pressure (PaO2) in arterial blood, higher Apnea Hypopnea Index (AHI), and a lower number of sleep hours per night. Chronic obstructive pulmonary disease (COPD) was more diagnosed in the group of patients with nocturnal respiratory failure. A lower number of total sleep hours, lower daytime PaO2, lower AHI, increased oxygen desaturation index (ODI), and the presence of a diagnosed COPD were all found to increase the risk of having nocturnal respiratory failure.

Conclusion

COPD, AHI, ODI, daytime PaO2, and total sleep hours are the main predictors for NRF in patients with moderate and severe OSAS.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

AUC:

Area under the curve

AHI:

Apnea Hypopnea Index

COPD:

Chronic obstructive pulmonary disease

GERD:

Gastroesophageal reflux disease

IQR:

Median and interquartile ranges

NRF:

Nocturnal respiratory failure

OHS:

Obesity hypoventilation syndrome

OSAS:

Obstructive sleep apnea syndrome

ODI:

Oxygen desaturation index

ROC:

Receiver operating characteristic

SD:

Standard deviation

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Acknowledgements

We thank all the physicians, nurses, and healthcare professionals who gave us great support

during this study.

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Authors and Affiliations

  1. Department of Basic Medical Science, Neuroscience and Sense Organs, University of Medicine “Aldo Moro”, Bari, Italy

    Andrea Portacci, Carla Santomasi, Valentina Di Lecce, Federica Barratta, Maria Luisa De Candia, Onofrio Resta & Giovanna Elisiana Carpagnano

  2. Bari, Italy

    Andrea Portacci

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Contributions

Dr Andrea Portacci participated in the design of the study, in the sequence of alignment, in the statistical analysis, and drafted the manuscript. Dr Carla Santomasi participated in the design of the study, in the interpetation of the results, and drafted the manuscript. Dr Valentina Di Lecce participated in the design of the study, in the interpetation of the results, and drafted the manuscript. Dr Federica Barratta participated in the in the literature research and in data acquisition. Dr Maria Luisa De Candia participated in the literature research and in data acquisition. Prof Onofrio Resta participated in the design of the study and in the final revision ot the manuscript. Prof Giovanna Elisiana Carpagnano participated in the design of the study, in the interpetation of the results, and in the final revision ot the manuscript. All authors read and approved the final manuscript. All the authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

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Ethics approval

The current study has been approved by Institutional Review Board of teaching Hospital Policlinic of Bari (Ethical Committee number: 6750) and, due to the nature of retrospective study, waived the need for informed consent from individual patients.

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The authors declare no competing interests.

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Portacci, A., Santomasi, C., Di Lecce, V. et al. Predictive tools for nocturnal respiratory failure in patients with moderate and severe OSAS. Sleep Breath 27, 611–620 (2023). https://doi.org/10.1007/s11325-022-02666-3

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  • DOI: https://doi.org/10.1007/s11325-022-02666-3

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