In this study, we investigated 2 PSG variables not previously explored in studies of PAP adherence—ORP and mean nocturnal SpO2—based on our hypothesis that a collapsible upper airway may impair sleep quality by disrupting sleep and/or by resulting in hypoventilation, depending on the arousal threshold and the ventilatory response to asphyxia. Because both high sleep ORP (light sleep) and hypercapnia can result from causes other than upper airway collapse, the other condition we imposed was that these abnormalities should be reversed by PAP titration. We reasoned that if these conditions are met, then sleep quality should improve on PAP to the point where the clinical benefits outweigh the challenges of using this therapy, resulting in good long-term adherence.
In developing the prediction model, we included all variables, conventional and ORP-related, that are readily available during routine diagnostic and PAP titration PSG and potentially contribute to nocturnal and daytime symptoms such that their improvement on PAP may facilitate PAP acceptance. Of the 1 such variables available in the diagnostic PSG studies, the 3 that were most strongly associated with PAP adherence were ORPNREM, AHI, and mean nocturnal SpO2 (from the first analysis).
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