Efficacy of daytime continuous positive airway pressure titration in severe obstructive sleep apnoea

Rudkowski, J C; Verschelden, P; Kimoff, R. John

doi:10.1183/09031936.01.00065501

Cited by 20 publications

(14 citation statements)

References 25 publications

(27 reference statements)

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“…There was no significant difference in CPAP pressure between nPSG and dPSG. Furthermore, previous studies showed no significant differences in terms of treatment compliance, symptom improvement, or side effects between pressures selected using daytime or nighttime PSG [24]. These results indicate that dPSG is also useful for early initiation of CPAP therapy.…”

Section: Discussionsupporting

confidence: 50%

“…Furthermore, despite the adequate titration of CPAP, pressure changes will be required after dPSG titration [26]. Despite these limitations of dPSG, this method is still reliable for identifying patients with moderate to severe OSAS [19][20][21], and daytime CPAP titration is an appropriate procedure for the effective titration of CPAP [24,26].…”

Section: Discussionmentioning

confidence: 99%

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Daytime polysomnography for early diagnosis and treatment of patients with suspected sleep-disordered breathing

et al. 2007

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Excessive daytime sleepiness (EDS) is a common complaint among patients with sleep-disordered breathing (SDB). Population-based studies on traffic and industrial accidents suggest a relationship between EDS and life-threatening events, and adults with EDS have cognitive and memory problems. Nocturnal polysomnography (nPSG) is essential for diagnosing SDB but it is time and energy consuming. We examined the usefulness of daytime polysomnography (dPSG) for the early diagnosis and treatment of patients with suspected SDB. We studied 108 consecutive patients aged 51.9 +/- 13.5 years (mean+/-SD). All patients underwent dPSG and nPSG. The number of apnea/hypopnea episodes per hour (apnea/hypopnea index: AHI) and the number of 3% desaturation episodes per hour (desaturation index: DSI) were calculated. All patients were classified into two groups. The REM group consisted of subjects who had an AHI < or = 25/h, AHI(REM)/AHI(NREM) > 2, and AHI(NREM) < 15/h. Those who did not satisfy these criteria were placed in the NREM group. Continuous positive airway pressure (CPAP) titration was performed for patients whose AHI was > or =20/h on dPSG. Using the international classification of sleep disorders, 96 patients were diagnosed as obstructive sleep apnea [including five upper airway resistance syndrome (UARS) patients], six patients were snoring, four had idiopathic hypersomnia due to a medical condition, and two had circadian rhythm sleep disorders. The sensitivity of dPSG for AHI was 81.0%, specificity was 100%, and accuracy was 83.5%. The sensitivity and accuracy of dPSG for AHI in the REM group were considerably lower than in the NREM group. There was no significant difference for optimal CPAP between dPSG and nPSG. In the five patients with UARS, their AHI, DSI, and arousal index on dPSG were 0.92 +/- 1.2/h, 2.9 +/- 3.4/h, and 29.3 +/- 3.5/h, respectively, and their AHI and DSI on nPSG were 3.2 +/- 2.5/h and 2.8 +/- 2.4/h, respectively. However, their respiratory effort-related arousals were 37.9 +/- 7.4/h, and their arousal index was 33.2 +/- 6.3/h. The five patients with UARS were also treated with CPAP, and their daytime sleepiness was improved. Although dPSG has limitations, these results indicate that dPSG recording is clinically useful for the diagnosis of and determination of types of treatment in patients with suspected SDB.

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Section: Discussionsupporting

confidence: 50%

Section: Discussionmentioning

confidence: 99%

Daytime polysomnography for early diagnosis and treatment of patients with suspected sleep-disordered breathing

et al. 2007

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“…Another advantage of our procedure was chronobiologically appropriate time slot when aPT was performed. In contrast to our method, the previous two studies (27,28) did the titration in the morning, and the one did not describe the time zone of their titration (29). Regarding the chronobiological change in the vigilance level, Lavie and Segal (30) demonstrated that sleep propensity was second highest in the early afternoon (i.e.…”

Section: Discussionmentioning

confidence: 85%

The new procedure for manual CPAP titration : the afternoon CPAP titration (aPT)

Kido

Tachibana

2021

J. Med. Invest.

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Study Objectives : Although the full-night continuous positive airway pressure (CPAP) titration (fnPT) has been recognized as the gold standard for determining an optimal therapeutic pressure for obstructive sleep apnea (OSA) treatment, it is labor-intensive, time-consuming because it requires overnight polysomnography attended by well-experienced sleep technologists. The aim of this study is to develop a practical and feasible alternative titration method. Methods : We assessed demographic data and diagnostic polysomnographic parameters, time spent in CPAP titration, CPAP efficacy and long-term adherence of the two groups of our OSA patients who had received CPAP titration either by fnPT (n = 46) or by afternoon CPAP titration (aPT, n = 22). Main results : Mean total recording time of aPT was significantly shorter than that by fnPT (p < 0.0001). There was no significant difference in mean residual apnea hypopnea index (AHI) on treatment, percent days with device usage, cumulative device usage hours during the 360 days, average device usage hours per day (360 days, days used), and percent of days with device usage ≥ 4 hours during the 360 days after starting CPAP treatment between the two groups. Conclusions : Our study demonstrated that aPT was feasible procedure as an alternative to fnPT. J.

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“…Most of the patients had their Bi-level PAP and new CPAP introduced during the daytime. There is evidence that PAP can be effectively introduced as a day care procedure [25] and this is routine practice in some UK centers. It is conceivable that the Bi-level device was not optimally set up.…”

Section: Discussionmentioning

confidence: 99%

The impact of changing people with sleep apnea using CPAP less than 4 h per night to a Bi-level device

Gulati

Oscroft

Chadwick

et al. 2015

Respiratory Medicine

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Pressure intolerance is a reason for poor acceptance and subsequent compliance in some patients starting treatment with continuous positive airway pressure (CPAP). In unselected populations initiating CPAP; different types of pressure generating device have not been found to improve compliance. We hypothesized that using Bi-level PAP for patients who reported pressure related discomfort as a cause for poor compliance with CPAP might increase their hours of treatment use. Patients using CPAP <4 h/night with symptoms to suggest pressure intolerance were randomized to receive either a Bi-level PAP device or a new CPAP for 4 weeks. Following a washout period of 2 weeks, they were crossed over to the other device for 4 weeks. Twenty eight volunteers completed the protocol. Compared to the baseline (mean 1.49 h per night), improvement in compliance was noticed when changed to a new CPAP (2.23 h, p = 0.006) or Bi-level PAP (2.73 h, p < 0.001). The trend suggesting superior compliance with a Bi-level PAP device compared to new CPAP was not significant (p = 0.059) and there were no differences in subjective or objective measures of sleepiness. The results of this study suggest that routine intervention with Bi-level PAP in this group of sub-optimally compliant individuals was not very effective in improving PAP usage. There is however a subgroup of patients who complains of difficulty with exhalation; where favorable trends towards improved compliance were observed on Bi-level PAP.

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Efficacy of daytime continuous positive airway pressure titration in severe obstructive sleep apnoea

Cited by 20 publications

References 25 publications

Daytime polysomnography for early diagnosis and treatment of patients with suspected sleep-disordered breathing

Daytime polysomnography for early diagnosis and treatment of patients with suspected sleep-disordered breathing

The new procedure for manual CPAP titration : the afternoon CPAP titration (aPT)

The impact of changing people with sleep apnea using CPAP less than 4 h per night to a Bi-level device

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