Automatic Derivation of Continuous Positive Airway Pressure Settings: Comparison with In-Laboratory Titration

Abstract

Background and PurposeThis study was designed to investigate differences in the final recommended pressure setting between that derived from an autotitrating continuous positive airway pressure (APAP) device and manual in-laboratory continuous positive airway pressure (CPAP) titration, as well as the factors that influence pressure differences in patients with obstructive sleep apnea (OSA). MethodsThis study enrolled 50 patients with OSA. All patients underwent both APAP titration and manual CPAP titration. We obtained the average device pressure ≤90% of the time (APAP90) from the downloaded manual for the APAP machine and the optimal pressure obtained by manual CPAP titration (CPAPmanual). We placed the subjects into three groups based on the pressure difference (ΔP) obtained by subtracting CPAPmanual from APAP90: 1) Prequal (ΔP=0), 2) CPAPmanual+ (ΔP ≤-1), and 3) APAP90+ (ΔP ≥1). Regression analysis was conducted to identify predictive factors associated with ΔP. ResultsThe values of APAP90 and CPAPmanual were 9.50±3.03 cmH2O and 9.48±2.71 cmH2O (mean±SD), respectively (p=0.95). The Prequal, CPAPmanual+, and APAP90+ groups comprised 9 (18%), 23 (46%), and 18 (36%) subjects, respectively. Regression analyses revealed that male sex [β=3.539, 95% confidence interval (CI)=0.040-7.039], body mass index (BMI) (β=0.186, 95% CI=0.020-0.352), and average usage per day (β=0.768, 95% CI=0.077-1.459) were associated with ΔP.Conclusions While the mean pressure in the overall cohort did not differ significantly between APAP90 and CPAPmanual, there was a discordance majority showing different single pressures obtained when applying the two titration methods. Being Male, having an increased BMI, and having an increased average usage per day of APAP were significantly correlated with increased ΔP in this study. cc This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. JCN Open Access ORIGINAL ARTICLEwww.thejcn.com 315 Kim H et al.

Alternative Procedure to Individual Nasal Pressure Titration for Sleep Apnea

“…Figure 1 shows information usually not provided in the literature and consists of the histogram of the actual pressure settings for nasal CPAP retained for treating 16,780 unselected patients who underwent conventional CPAP titration in the area of Catalonia, Spain. These data reveal that the mean (±SD) of CPAP pressures retained for the treatment of this large cohort of patients was 9.3 ± 1.7 cmH 2 O, and constitute pressure settings that are remarkably similar to those reported in many research studies involving smaller numbers of patients who were selected/excluded according to specific criteria [ 13 , 14 ]. Most interestingly, the real-life data in Figure 1 indicate that 67.4% of patients are treated with CPAP values within a range of 8–10 cmH 2 O, i.e., differing by only ±1 cmH 2 O from the mean of 9 cmH 2 O.…”

Optimal positive airway pressure requirement and polysomnography indices of obstructive sleep apnea severity in the Saudi population

“…The median optimal PAP requirement reported in this study tended to be higher than that reported in the literature. [ 21 22 ] This may be attributed to the majority of participants in the study using oronasal masks during the PAP titration polysomnography. [ 23 24 ] Nonetheless, we found a direct relationship between the optimal PAP requirement and OSA severity, as has been suggested in previous reports.…”

Brazilian Thoracic Association Consensus on Sleep-disordered Breathing

“…Vários estudos não encontraram diferenças estatisticamente significativas entre as pressões médias de tratamento obtidas pela titulação domiciliar com APAP ou com a titulação manual em laboratório de sono. (110,(161)(162)(163) Uma meta-análise englobando 10 ensaios clínicos randomizados comparou o uso da pressão positiva usando titulação domiciliar com APAP versus titulação de pressão positiva no laboratório: não houve diferenças clinicamente significativas na adesão, sonolência ou qualidade de vida entre os grupos. (150) Um ensaio clínico randomizado avaliou a preferência do paciente em relação à conduta diagnóstica/terapêutica no laboratório versus no domicílio, sendo que 62% dos participantes randomizados para o laboratório teriam preferido o manejo domiciliar em comparação com 6% dos participantes no grupo ambulatorial que teriam preferido o manejo laboratorial.…”