Comparison of manual titration and automatic titration based on forced oscillation technique, flow and snoring in obstructive sleep apnea

• Published in: Sleep medicine 2009-03, Vol.10 (3), p.337-343
• Main Authors: Galetke, Wolfgang, Randerath, Winfried J, Stieglitz, Sven, Laumanns, Cordula, Anduleit, Norbert, Richter, Kerstin, Schäfer, Thorsten
• Format: Article
• Language: English
• Subjects: Adult; Automatic continuous positive airway pressure; Automatic titration; Continuous Positive Airway Pressure - instrumentation; Continuous Positive Airway Pressure - methods; Continuous Positive Airway Pressure - standards; Cross-Over Studies; Female; Follow-Up Studies; Forced oscillation technique; Humans; Male; Middle Aged; Nasal continuous positive airway pressure; Neurology; Obstructive sleep apnea; Polysomnography; Pressure; Reference Standards; Sleep Apnea, Obstructive - diagnosis; Sleep Apnea, Obstructive - therapy; Sleep Medicine; Titration
• ISSN: 1389-9457; 1878-5506
• DOI: 10.1016/j.sleep.2008.03.007

Abstract Background Continuous positive airway pressure (CPAP) treatment in obstructive sleep apnea syndrome (OSAS) requires pressure titration usually performed during attended in-hospital polysomnography. This manual titration procedure is not well standardized. The aim of the study was to ascertain whether a new automatic titration device is as effective as standard manual titration in determining constant CPAP pressure. Methods We included 38 patients with a newly diagnosed OSAS. Participants were randomly assigned to attended in-laboratory manual titration and automatic titration in two consecutive nights. Fixed CPAP pressure was set at the optimal pressure determined during the second night. The follow-up period was 6 weeks. Main outcomes were apnea/hypopnea index (AHI) and Epworth sleepiness scale (ESS). Results AHI (manual: baseline 40.5 ± 21.5/h vs. treatment 6.4 ± 3.3/h ( p < 0.001); automatic: 53.3 ± 28.1/h vs. 7.8 ± 3.3/h ( p < 0.001)) and ESS (manual: 11.3 ± 4.7 vs. 8.8 ± 5.1 (ns); automatic: 11.5 ± 5.6 vs. 7.0 ± 3.8 ( p < 0.05)) showed a similar improvement in both groups. Pressure recommendation by the device and the technician, although not statistically different (8.7 ± 2.9 vs. 9.0 ± 3.3 mbar), corresponded only in 50% of the patients. Conclusions Automatic titration effectively predicts constant CPAP pressure for long-term treatment when performed during an attended polysomnography. Careful evaluation of raw data and polysomnography recording is mandatory before choosing a fixed CPAP pressure after automatic titration.