Analyzing Neck Circumference as an Indicator of CPAP Treatment Response in Obstructive Sleep Apnea with Network Medicine

We explored the relationship between obstructive sleep apnea (OSA) patients’ anthropometric measures and the CPAP treatment response. To that end, we processed three non-overlapping cohorts (<inline-formula><math display="inline"><semantics><msub><mi>D</mi&...

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Bibliographic Details
Main Authors: Stefan Mihaicuta, Lucreţia Udrescu, Mihai Udrescu, Izabella-Anita Toth, Alexandru Topîrceanu, Roxana Pleavă, Carmen Ardelean
Format: Article
Language:English
Published: MDPI AG 2021-01-01
Series:Diagnostics
Subjects:
Online Access:https://www.mdpi.com/2075-4418/11/1/86
Description
Summary:We explored the relationship between obstructive sleep apnea (OSA) patients’ anthropometric measures and the CPAP treatment response. To that end, we processed three non-overlapping cohorts (<inline-formula><math display="inline"><semantics><msub><mi>D</mi><mn>1</mn></msub></semantics></math></inline-formula>, <inline-formula><math display="inline"><semantics><msub><mi>D</mi><mn>2</mn></msub></semantics></math></inline-formula>, <inline-formula><math display="inline"><semantics><msub><mi>D</mi><mn>3</mn></msub></semantics></math></inline-formula>) with 1046 patients from four sleep laboratories in Western Romania, including 145 subjects (<inline-formula><math display="inline"><semantics><msub><mi>D</mi><mn>1</mn></msub></semantics></math></inline-formula>) with one-night CPAP therapy. Using <inline-formula><math display="inline"><semantics><msub><mi>D</mi><mn>1</mn></msub></semantics></math></inline-formula> data, we created a CPAP-response network of patients, and found neck circumference (NC) as the most significant qualitative indicator for apnea–hypopnea index (AHI) improvement. We also investigated a quantitative NC cutoff value for OSA screening on cohorts <inline-formula><math display="inline"><semantics><msub><mi>D</mi><mn>2</mn></msub></semantics></math></inline-formula> (OSA-diagnosed) and <inline-formula><math display="inline"><semantics><msub><mi>D</mi><mn>3</mn></msub></semantics></math></inline-formula> (control), using the area under the curve. As such, we confirmed the correlation between NC and AHI (<inline-formula><math display="inline"><semantics><mrow><mi>ρ</mi><mo>=</mo><mn>0.35</mn></mrow></semantics></math></inline-formula>, <inline-formula><math display="inline"><semantics><mrow><mi>p</mi><mo><</mo><mn>0.001</mn></mrow></semantics></math></inline-formula>) and showed that 71% of diagnosed male subjects had bigger NC values than subjects with no OSA (area under the curve is 0.71, with 95% CI 0.63–0.79, <inline-formula><math display="inline"><semantics><mrow><mi>p</mi><mo><</mo><mn>0.001</mn></mrow></semantics></math></inline-formula>); the optimal NC cutoff is 41 cm, with a sensitivity of 0.8099, a specificity of 0.5185, positive predicted value (PPV) = 0.9588, negative predicted value (NPV) = 0.1647, and positive likelihood ratio (LR+) = 1.68. Our NC <inline-formula><math display="inline"><semantics><mrow><mo>=</mo><mn>41</mn></mrow></semantics></math></inline-formula> cm threshold classified the <inline-formula><math display="inline"><semantics><msub><mi>D</mi><mn>1</mn></msub></semantics></math></inline-formula> patients’ CPAP responses—measured as the difference in AHI prior to and after the one-night use of CPAP—with a sensitivity of 0.913 and a specificity of 0.859.
ISSN:2075-4418