Comparison of conventional nighttime with automatic or manual daytime CPAP titration in unselected sleep apnea patients: study of the usefulness of daytime titration studies

Abstract

Daytime CPAP titration studies with full polysomnography have been successfully performed in patients with severe sleep apnea-hypopnea syndrome (SAHS). The implementation of daytime studies in unselected SAHS patients could help to reduce the waiting lists for CPAP titrations. The main purpose of this study was to compare the effectiveness of conventional versus manual or automatic daytime CPAP titration in unselected patients with SAHS. Ninety-three consecutive patients with SAHS in whom CPAP was indicated were assigned to conventional titration or to manual or automatic (AutoSet) daytime CPAP titration, after sleep deprivation. The number of valid studies, sleep architecture, final pressure selected and mean pressure in the different sleep stages were compared. Changes in sleepiness (Epworth sleepiness score) and hours of CPAP use were assessed after 3 months of treatment. Four patients did not sleep (3 AutoSet, 1 conventional daytime groups). Sleep latency was shorter during automatic daytime titration whereas REM latency was shorter in daytime studies; the percentage of sleep stages was similar during all types of titration. CPAP requirements were significantly higher during REM sleep in conventional and manual daytime titrations while mean pressure was unchanged throughout sleep stages during AutoSet titration. CPAP pressure selected with conventional or daytime manual titration (7.5(2.2) cm H2O and 7.4(1.5) cm H2O, ns) were significantly lower (P< 0.001) than with AutoSet (9.4(1.6) cm H20. All groups showed similar decrease of sleepiness and hours of use of CPAP at 3 months of follow-up. Automatic and manual daytime PSG studies after sleep deprivation are useful for CPAP titration in unselected patients with SAHS. Pressure selected with AutoSet is significantly higher than with conventional daytime or nighttime titration, although not significant in terms of treatment compliance and symptom improvement.

A randomized cross‐over study of auto‐continuous positive airway pressure versus fixed‐continuous positive airway pressure in patients with obstructive sleep apnoea

“…The mean pressure of auto‐CPAP tends to be lower than fixed‐CPAP in general, but some auto‐CPAP devices may not respond adequately 32,33 . While some studies showed certain brands of auto‐CPAP devices to be superior to fixed‐CPAP in improving clinical parameters and compliance, the results are inconsistent 18–26 (Table 4). In a bench study, different brands of auto‐CPAP devices were found to perform differently 34 …”

“…Guidelines on the use of auto‐CPAP are available from the Task Force of the Standards of Practice Committee of the American Academy of Sleep Medicine 17 . Numerous studies have compared different auto‐CPAP devices against fixed‐CPAP for treatment purposes, but the results are inconsistent 18–26 . This study compared the efficacy of auto‐ versus fixed‐CPAP in improving sleepiness and health status in Chinese patients in Hong Kong with severe OSA.…”

Positive-pressure treatment of obstructive sleep apnea syndrome

“…Compliance with treatment and symptom improvement were similar at 3 months among 93 OSAS patients whether titrated to CPAP by conventional manual in-lab night titration, or manual or autodaytime titration after sleep deprivation, though pressure selected with auto-CPAP was significantly higher (Lloberes et al, 2004). In patients with high within-night variability in pressure requirements, the use of auto-CPAP compared with fixed-pressure CPAP did not confer compliance advantage and both methods were equivalent in terms of AHI reduction; however, mean Epworth Sleepiness Scale score was slightly and significantly lower on auto-CPAP (Noseda et al, 2004).…”

APAP and Alternative Titration Methods

“…Subsequently, using older generation APAP devices, investigators have demonstrated that the “fixed” CPAP pressure determined by APAP therapy can either be the same, greater, or less than that derived from attended PSG (17–20). Such a simplistic comparison, however, should probably not be made considering that; the gold standard itself suffers from inherent limitations – cost, inconvenience of electrode placements, laboratory versus home environment, and limited “one-night” sampling.…”