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BACKGROUND: Obstructive sleep apnoea (OSA) is highly prevalent and associated with cardiovascular and metabolic changes. OSA is usually diagnosed by polysomnography which is time-consuming and provides little information on the patient's phenotype thus limiting a personalised treatment approach. Exhaled breath contains information on metabolism which can be analysed by mass spectrometry within minutes. The objective of this study was to identify a breath profile in OSA recurrence by use of secondary-electrospray-ionization-mass spectrometry (SESI-MS). METHODS: Patients with OSA effectively treated with CPAP were randomised to either withdraw treatment (subtherapeutic CPAP) or continue therapeutic CPAP for 2 weeks. Exhaled breath analysis by untargeted SESI-MS was performed at baseline and 2 weeks after randomisation. The primary outcome was the change in exhaled molecular breath pattern. RESULTS: 30 patients with OSA were randomised and 26 completed the trial according to the protocol. CPAP withdrawal led to a recurrence of OSA (mean difference in change of oxygen desaturation index between groups +30.3/h; 95% CI 19.8/h,40.7/h, p<0.001) which was accompanied by a significant change in 62 exhaled features (16 metabolites identified). The panel of discriminating mass-spectral features allowed differentiation between treated and untreated OSA with a sensitivity of 92.9% and a specificity of 84.6%. CONCLUSION: Exhaled breath analysis by SESI-MS allows rapid and accurate detection of OSA recurrence. The technique has the potential to characterise an individual's metabolic response to OSA and thus makes a comprehensible phenotyping of OSA possible. TRIAL REGISTRATION NUMBER: NCT02050425 (registered at ClinicalTrials.gov).

Original publication

DOI

10.1136/thoraxjnl-2015-207597

Type

Journal article

Journal

Thorax

Publication Date

02/2016

Volume

71

Pages

110 - 117

Keywords

Exhaled Airway Markers, Sleep apnoea, Adult, Aged, Breath Tests, Continuous Positive Airway Pressure, Exhalation, Female, Follow-Up Studies, Humans, Male, Middle Aged, Oxygen, Oxygen Consumption, Polysomnography, Retrospective Studies, Sleep Apnea, Obstructive, Ventilator Weaning, Withholding Treatment, Young Adult