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CPAP washout prior to reevaluation polysomnography: a sleep surgeon’s perspective

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Abstract

Purpose

Obstructive sleep apnea (OSA) is characterized by repetitive upper airway collapse during sleep, leading to decreased oxygen blood levels and arousal from sleep. The gold standard treatment option for moderate to severe OSA is considered continuous positive airway pressure (CPAP). In case primary treatment with CPAP fails, a reevaluation of disease severity [by means of the apnea/hypopnea-index (AHI)] can be required. A subset of patients that prefer a CPAP alternative is still using CPAP until the reevaluation polysomnography (PSG), and a so-called washout effect is not ruled out. The purpose of this study is to evaluate the evidence on the existence and duration of this washout effect and its clinical relevance for current practice.

Methods

To identify papers for this review, an extensive literature search was run electronically through MEDLINE and EMBASE databases.

Results

An overview of currently available literature on this washout effect and the findings of 13 studies on this topic are discussed.

Conclusion

There is some evidence that CPAP washout exists in patients with a stable BMI throughout the follow-up period. However, the intensity and duration of this effect remains unclear. Within the limitations of the present study, it seems reasonable to maintain a washout period of 1 week, in case alternative treatments options are considered and especially when a baseline PSG (and subsequent repeat PSG after treatment) is needed in case of clinical trials.

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Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

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Authors and Affiliations

  1. Department of ENT, Head and Neck Surgery, Saint Lucas Andreas Hospital, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands

    Anneclaire V. M. T. Vroegop, Jim W. Smithuis, Linda B. L. Benoist & Nico de Vries

  2. Department of ENT, Head and Neck Surgery, Antwerp University Hospital, Edegem, Antwerp, Belgium

    Anneclaire V. M. T. Vroegop, Olivier M. Vanderveken & Nico de Vries

  3. Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium

    Anneclaire V. M. T. Vroegop, Olivier M. Vanderveken & Nico de Vries

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  1. Anneclaire V. M. T. Vroegop
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  2. Jim W. Smithuis
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  3. Linda B. L. Benoist
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  4. Olivier M. Vanderveken
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Correspondence to Anneclaire V. M. T. Vroegop.

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Vroegop, A.V.M.T., Smithuis, J.W., Benoist, L.B.L. et al. CPAP washout prior to reevaluation polysomnography: a sleep surgeon’s perspective. Sleep Breath 19, 433–439 (2015). https://doi.org/10.1007/s11325-014-1086-6

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  • DOI: https://doi.org/10.1007/s11325-014-1086-6

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