0654 Periodic Breathing as a Predictor of Failure in Home CPAP Titration for Obstructive Sleep Apnea

Abstract Introduction Introduction Periodic breathing (PB) is characterized by periods of respiratory instability and is commonly observed in patients with obstructive sleep apnea (OSA) in whom a high loop gain endotype predominates (i.e., an exaggerated ventilatory response to changes in ventilation). High levels of periodic breathing have previously been linked to CPAP failure using algorithms that detect PB from the nasal pressure signal during sleep studies. The aim of this study was to evaluate the association between periodic breathing and success or failure of home CPAP titration. Methods Materials and Methods This was a cross-sectional, retrospective study. We included adult patients diagnosed with OSA who were prescribed home titration with an auto-adjusting CPAP device (APAP; AirSense 10, ResMed) for three nights using a standard pressure range of 5–20 cm H₂O. The raw nasal pressure signal from the diagnostic polysomnography was exported in European Data Format (EDF) and analyzed for periodic breathing using Spyder software (Python) version 5.5.1. The primary outcome was titration failure, defined as a residual apnea-hypopnea index (AHI) 10 events/hour and/or average CPAP use 4 hours/night during the titration period. Results Results A total of 292 adults were included: 60% were male, median age was 56 years (IQR 48–65.8), median baseline AHI was 36.7 events/hour (IQR 24.8–61.5), and 14% had cardiovascular disease. Elevated periodic breathing (≥20% of total recording time) was independently associated with a higher likelihood of titration failure (adjusted OR 2.73; 95% CI 1.09–6.67; p = 0.028) after adjustment for age, body mass index, sex, OSA severity, cardiovascular disease, mask type, 95th percentile CPAP pressure, mask leak, and use of expiratory pressure relief. Conclusion Conclusions In this cohort, a high burden of periodic breathing was an independent predictor of failure during home CPAP titration. These findings support the concept that initial CPAP response is influenced by underlying physiological phenotypes and highlight periodic breathing as a valuable biomarker for personalizing treatment in patients with obstructive sleep apnea. Support (if any) GL was supported by Fondecyt grant (Chile) number 11240972