Fraction of apnea is associated with the required continuous positive airway pressure level and reflects upper airway collapsibility in patients with obstructive sleep apnea

Study Objectives: We aimed to determine whether the fraction of apnea (Fapnea) could be used as an alternative index to reflect upper airway collapsibility. Methods: We retrospectively recruited 161 patients (16 women, mean age 47.8 years, body mass index [BMI] 28.0 kg/m(2), and apnea-hypopnea index 46.4 events/h) with moderate to severe obstructive sleep apnea who had undergone nasal continuous positive airway pressure (CPAP) titration. Fapnea is defined as the percentage of apneic events relative to the total number of apneic and hypopneic events during sleep in a supine position on diagnostic polysomnography. We randomly split the data (70/30) into the development and validation datasets. In the development dataset, we conducted a multiple regression analysis to assess the association of variables, including age, sex, BMI, supine rapid eye movement (REM) sleep apnea-hypopnea index, and apnea with a CPAP level during supine REM sleep (REM_CPAP). Moreover, we developed an equation for predicting the CPAP level. Thereafter, we evaluated the correlation between the actual CPAP level and the value calculated using the model. Results: BMI and Fapnea were the only significant factors that predicted the REM_CPAP level (adjusted r= .60, P< .001) in the development dataset. The validation data revealed a significant correlation between the actual and predicted CPAP levels (r= .69, P< .0001). We observed similar associations during supine non-REM sleep. Conclusions: Fapnea could significantly predict the CPAP levels during both REM and non-REM sleep, which likely reflects the upper airway collapsibility, independent of the BMI.