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• W3178157617 abstract "Free AccessLetters to the EditorSex differences in therapeutic CPAP levels in adults Ricardo L.M. Duarte, MD, PhD, Flavio J. Magalhães-da-Silveira, MD, David Gozal, MD, MBA Ricardo L.M. Duarte, MD, PhD SleepLab—Laboratório de Estudo dos Distúrbios do Sono, Rio de Janeiro, Brazil; Instituto de Doenças do Tórax—Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil; Search for more papers by this author , Flavio J. Magalhães-da-Silveira, MD SleepLab—Laboratório de Estudo dos Distúrbios do Sono, Rio de Janeiro, Brazil; Search for more papers by this author , David Gozal, MD, MBA Address correspondence to: David Gozal, MD, MBA, Department of Child Health, University of Missouri School of Medicine, 400 North Keene Street, Suite 010, Columbia, MO 65201; Email: E-mail Address: [email protected] Department of Child Health, University of Missouri School of Medicine, Columbia, Missouri Search for more papers by this author Published Online:January 1, 2022https://doi.org/10.5664/jcsm.9536SectionsPDF ShareShare onFacebookTwitterLinkedInRedditEmail ToolsAdd to favoritesDownload CitationsTrack Citations AboutINTRODUCTIONWe thank you for your interest in our study1 and for the opportunity to clarify some of the issues raised by Zheng et al.2 Our cross-sectional study showed that the therapeutic levels of continuous positive airway pressure (CPAP) derived from an auto-adjusting CPAP titration were similar between men and women who were diagnosed as experiencing moderate to severe obstructive sleep apnea (OSA).1 OSA is a highly prevalent disease that is often associated with cardiovascular and metabolic complications, and regular CPAP therapy is the standard treatment for individuals diagnosed with OSA, especially in its more severe forms.3,4Based on extant evidence, we hypothesized that women would require lower therapeutic CPAP levels than men. Indeed, a previous study of 95 retrospectively enrolled adults (56 women and 39 men) suggested that this might be the case.5 However, our study in a much larger cohort did not reveal any sex-related differences in the therapeutic levels of CPAP.1 Some issues deserve comment regarding the aforementioned study by Jayaraman et al,5 namely a surprising predominance in the number of women with OSA and no sex-related statistically significant differences in the baseline apnea-hypopnea index values​ (P = .13). These characteristics strikingly differ from the usual epidemiological attributes of patients with OSA, in whom men predominate, especially patients with the more severe forms of OSA.3 Furthermore, as previously commented on in our study,1 there was no mention of the type of mask used by the individuals during the CPAP titration.5 Recent evidence strongly suggests that with the use of an oronasal mask, the optimal CPAP levels obtained during a titration study tend to be higher than those obtained during titration with a nasal mask.6,7 Our study,1 which prospectively enrolled 1,006 adult individuals with a diagnosis of moderate to severe OSA over a 4-year period, had a predominance of men (n = 652), and men had statistically higher median baseline apnea-hypopnea index values ​​than women (43.1 events/h vs 36.7 events/h; P < .001).1Further analyses revealed that factors such as body mass index, age, and baseline apnea-hypopnea index values ​​(obtained exclusively using full polysomnography in a sleep laboratory setting) were independent predictors of the therapeutic CPAP pressure settings.1 Although body mass index and age are well-defined risk factors in the pathophysiology of OSA,3 their role in determining therapeutic CPAP levels deserves further exploration. We agree with Zheng and colleagues2 that different population groups have different clinical, demographic, and anthropometric characteristics, all of which can decisively influence the findings across studies. Considering that our study was carried out in a single center, it is susceptible to these pertinent criticisms, and therefore generalization of the findings may be limited, as indicated in the discussion section of the article.1 Therefore, future multicenter studies will undoubtedly help solve this issue.DISCLOSURE STATEMENTThis was not an industry-supported study. The authors report no conflicts of interest.REFERENCES1. Duarte RLM, Magalhães-da-Silveira FJ, Gozal D. Are there sex-related differences in therapeutic CPAP levels in adults undergoing in-lab titration? J Clin Sleep Med. 2021;17(9):1815–1820. LinkGoogle Scholar2. Zheng Z, Hong C, Lu J, Zhuang C, Zhang N, Chen R. Does sex difference play an important role in therapeutic CPAP levels? J Clin Sleep Med. 2022;18(1):329–330. LinkGoogle Scholar3. Kapur VK, Auckley DH, Chowdhuri S, et al.. Clinical practice guideline for diagnostic testing for adult obstructive sleep apnea: An American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med. 2017;13(3):479–504. LinkGoogle Scholar4. Patil SP, Ayappa IA, Caples SM, Kimoff RJ, Patel SR, Harrod CG. Treatment of adult obstructive sleep apnea with positive airway pressure: an American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med. 2019;15(2):335–343. LinkGoogle Scholar5. Jayaraman G, Majid H, Surani S, Kao C, Subramanian S. Influence of gender on continuous positive airway pressure requirements in patients with obstructive sleep apnea syndrome. Sleep Breath. 2011;15(4):781–784. CrossrefGoogle Scholar6. Duarte RLM, Mendes BA, Oliveira-E-Sá TS, Magalhães-da-Silveira FJ, Gozal D. Nasal versus oronasal mask in patients under auto-adjusting continuous positive airway pressure titration: a real-life study. Eur Arch Otorhinolaryngol. 2020;277(12):3507–3512. CrossrefGoogle Scholar7. Genta PR, Kaminska M, Edwards BA, et al.. The importance of mask selection on continuous positive airway pressure outcomes for obstructive sleep apnea. An official American Thoracic Society workshop report. Ann Am Thorac Soc. 2020;17(10): 1177–1185. CrossrefGoogle Scholar Previous article Next article FiguresReferencesRelatedDetails Volume 18 • Issue 1 • January 1, 2022ISSN (print): 1550-9389ISSN (online): 1550-9397Frequency: Monthly Metrics History Submitted for publicationJune 28, 2021Submitted in final revised formJuly 1, 2021Accepted for publicationJuly 1, 2021Published onlineJanuary 1, 2022 Information© 2022 American Academy of Sleep Medicine" @default.
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