The Science Journal of the American Association for Respiratory Care

2005 OPEN FORUM Abstracts

COMPARISON OF CPAP TITRATION TECHNIQUES FOR PATIENTS WITH MILD SLEEP APNEA

James C. Duke1,2, Ph.D., RPSGT and Staci Galle2, CRT, RPSGT

1. Sleep Diagnostic Services of Deaconess Hospital at Bethany, Bethany, Ok!.

2. Sleep Disorders Center, Hendrick Medical Center, Abilene, Tx.

Nasal CPAP has become the standard of care for the treatment of obstructive sleep apnea. Traditional CPAP devices have evolved into machines that continuously assess airway patency and adjust pressures upward or downward depending on a predefined algorhythm. The use of auto-titrating CPAP may provide significant advantages in the management of patients with mild sleep apnea if their reliability is established. This investigation was directed at determining the comparability of auto-titrating CPAP (AutoSet Spirit and Remstar Auto) with traditional 2 night and split-night titration evaluations. Forty-eight patients (10 females and 6 males) who underwent CPAP auto-titration, traditional single night titration, and split-night titration evaluations were selected. Patients with apnea-hypopnea indices between 10 and 15 events/hour were chosen as this group is typically difficult to "split" in a single night due to the scarcity of their apneas and typically require little pressure to resolve their respiratory anomalies. Patients were matched on age (±5 years), BMI (± 3), and sex. Auto-titration devices were set to range from 5 to 11 cm H2O with a pressure profile collected after 7 days use (range 5-9 days). Therapeutic CPAP pressures for the three methodologies were compared (see table).

Table 1. Comparison of therapeutic CPAP pressures.

DEMOGRAPHICS 10 < AHI < 15 Traditional Titration Split-night Titration Auto-adjust
SEX BMI AGE UAO Index Hypop Index AHI Mean Press AHI Mean Press AHI Mean* Press
F 30.1 43.4 1.9 10.7 0.7 7.2 (5-9) 0.9 7.7 (6-9) 1.8 8.8 (5-11)
M 33.6 46.7 3.8 10.4 1.0 7.6 (5-10) 0.9 7.9 (6-9) 2.4 8.0 (5-11)

* Mean represents the average of the 50th percentile with either 90th or 95th percentile.

Comparison of the average differences demonstrated no statistical differences using ANOVA for a matched design. In conclusion, auto-titrating CPAP represents an adequate alternative to traditional and split night polysomnography in establishing therapeutic pressures in patients with mild sleep apnea.

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