The Baveno classification as a predictor of CPAP titration pressure in obstructive sleep apnea syndrome

Abstract

Abstract Introduction: Obstructive sleep apnea syndrome (OSAS) is defined as a clinical condition characterized by repeated periods of partial or full obstruction of airflow throughout sleep, with a known impairment of the quality of life and increased mortality as well as the socioeconomic impacts. Continuous positive airway pressure (CPAP) therapy is a simple and effective treatment option for patients with OSAS. To overcome the clinical and prognostic limitations of the apnea–hypopnea index (AHI) – as a sole index of OSAS – the Baveno classification was recently set out and introduced in the clinical practice. This study aims to analyze the effect of the Baveno classification on the optimum CPAP titration pressure. Patients and methods: A retrospective analysis of the records of sleep studies in two centers between 2018 and 2021 was carried out. Patients diagnosed with OSAS and recruited for CPAP titration were included in the study. In accordance with the Baveno classification, the patients were categorized into four groups (A, B, C, and D), depending on their symptoms and the presence of comorbidities. Results: A total number of 700 patients were analyzed and 427 patients with OSAS were finally included in the study. A significant positive correlation was detected between CPAP optimum titration pressure on one side and OSAS severity, neck circumference, the oxygen desaturation index (ODI), mean oxygen saturation, the AHI, the body mass index (BMI), and cumulative sleep time when SpO2 was <90% (T90) on the other side (p: <0.0001). In contrast, a nonsignificant correlation was seen between the Epworth Sleepiness Scale (ESS), symptoms severity, end-organ impact, and Baveno’s classification with CPAP optimum titration pressure (p: 0.8, 0.4, 0.5, and 0.7, respectively). Conclusion: The Baveno classification is not useful in the prediction of CPAP optimum titration pressure. However, the ODI and neck circumference were significant independent predictors of higher CPAP titration pressure.