The Effect of One Versus Two Nights of In-Laboratory Continuous Positive Airway Pressure Titration on Continuous Positive Airway Pressure Compliance

Kaplan, Julia L; Chung, Sharon A.; Fargher, Terence; Shapiro, Colin M.

doi:10.1080/15402000701190614

Cited by 6 publications

(5 citation statements)

References 44 publications

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“…A first night effect of CPAP application on sleep architecture has also been described by other researchers (Kaplan et al, 2007; Lorenzo and Barbanoj, 2002); however, it should not have caused the differential effect of PLM indices seen between CPAP groups in our study. The literature also cites evidence of increased PLM arousal indices over continued CPAP use, as the arousal threshold is lowered after an initial sleep rebound and the brain is more susceptible to register EMG activation, further reinforcing the “unmasking” theory (Fry et al, 1989; Kaplan et al, 2007).…”

Section: Discussionsupporting

confidence: 79%

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Unmasking of Periodic Limb Movements With the Resolution of Obstructive Sleep Apnea During Continuous Positive Airway Pressure Application

Hedli

Christos

Krieger

2012

Journal of Clinical Neurophysiology

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Purpose Periodic limb movements (PLMs) and obstructive sleep apnea (OSA) may present as overlapping conditions. This study investigated the occurrence of PLM during continuous positive airway pressure (CPAP) titration, with the hypothesis that the presence of PLM during CPAP represented “unmasking” of a coexisting sleep disorder. Methods A total of 78 polysomnographic recordings in 39 OSA subjects with an hourly PLM index ≥5 during CPAP application were evaluated. Results Application of CPAP significantly improved sleep architecture without change in the PLM index when compared with baseline. The PLM indices and PLM arousal indices were linearly correlated during both nights (r = 0.553, P < 0.01; r = 0.548, P < 0.01, respectively). Eleven subjects with low PLM indices at baseline had greater changes in the PLM index as compared with the sample remainder (P = 0.004). Sixteen subjects with significantly lower PLM indices at baseline required optimal CPAP levels higher than the sample average of 8.2 cm H2O (P = 0.032). These subjects also showed significantly higher median apnea–hypopnea index (AHI) at baseline than the sample remainder (74.4 events per hour [range: 24.2–124.4 events per hour] vs. 22.7 events per hour [range: 8.6–77.4 events per hour], respectively, P < 0.001). Conclusions These findings suggest that PLM seen during CPAP titration may be related to a concurrent sleep disorder because of “unmasking” in patients with treated OSA.

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Section: Discussionsupporting

confidence: 79%

“…The literature also cites evidence of increased PLM arousal indices over continued CPAP use, as the arousal threshold is lowered after an initial sleep rebound and the brain is more susceptible to register EMG activation, further reinforcing the “unmasking” theory (Fry et al, 1989; Kaplan et al, 2007). …”

Section: Discussionmentioning

confidence: 90%

Unmasking of Periodic Limb Movements With the Resolution of Obstructive Sleep Apnea During Continuous Positive Airway Pressure Application

Hedli

Christos

Krieger

2012

Journal of Clinical Neurophysiology

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“…Another very influential finding is that relatively high adherence rates have been reported in some European studies where several nights of hospitalization upon initiation were the norm [82]. However, Kaplan et al did not find this when comparing one versus two titration nights, despite the a priori presumption was that a second night would be beneficial [83]. There may have been a ceiling effect in this study, which demonstrates some of the highest reported compliance rates.…”

Section: Healthcare Facilitymentioning

confidence: 35%

Factors that influence CPAP adherence: an overview

Shapiro

2010

Sleep Breath

155

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“…Polysomnographic studies are typically conducted in a sleep laboratory which is an unfamiliar environment for patients and is associated with the discomfort of being connected to a recording device with several wires. These environmental changes create a phenomenon known as the “first night effect” [ 7 ], which implicates changes in sleep quality and efficiency resulting in inaccurate and unrepresentative results. Moreover, there are differences in the recording techniques among different sleep laboratories, and until recently a lack of awareness of the implication of rapid eye movement (REM) and nonrapid eye movement (NREM) related apneas [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

“…In addition, the inconsistency of the results related to different criteria, such as the threshold of oxygen desaturation, exists between different laboratories. Some variability in sleep data may result due to night-to-night variability or the “first night effect” [ 7 ]. Further, in-laboratory PSG requires monitoring by an attending sleep technician.…”

Section: Introductionmentioning

confidence: 99%

A Comparison of Two Nights of Ambulatory Sleep Testing in Arrhythmia Patients

et al. 2018

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Introduction Obstructive sleep apnea (OSA) is common and usually underdetected in patients with cardiac arrhythmia. Ambulatory sleep testing may provide an alternative method for detection of OSA under realistic conditions compared to in-laboratory polysomnography. We aimed to (1) determine the sleep architecture in arrhythmia patients; (2) detect differences in sleep parameters between patients with and without OSA; and (3) compare the results of two consecutive nights of unattended ambulatory sleep testing. Methods Consecutive patients with unknown OSA status were recruited from arrhythmia clinics. Patients underwent two consecutive nights of self-applied in-home sleep testing replete with electroencephalogram (EEG) recording. Results One hundred patients were recruited. The mean age was 64 ± 13 years (70% males). OSA (AHI ≥ 5/h) was detected in 85% of patients. In the total sample, the sleep efficiency was reduced, and sleep onset latency was longer compared to a reference population of the same age. In patients with OSA, the sleep efficiency and the percentage of slow wave sleep were reduced; however, the arousal and periodic limb movement indices were increased compared to patients without OSA. The two nights of the ambulatory sleep testing showed consistent results with an excellent test-retest reliability for the AHI (ICC = 0.813). REM latency was shorter during the second night of sleep recording (p = 0.02). There were no other significant differences in the sleep architecture, respiratory indices, and other sleep parameters between the first and the second night of the ambulatory sleep recording. Conclusions There is no significant difference in the respiratory parameters obtained during two consecutive nights of ambulatory sleep testing. Ambulatory studies incorporating EEG may provide a reliable, convenient, and economically efficient method for sleep assessment and there appears to be no significant night-to-night variability.

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The Effect of One Versus Two Nights of In-Laboratory Continuous Positive Airway Pressure Titration on Continuous Positive Airway Pressure Compliance

Abstract: One versus two nights of CPAP titration did not affect CPAP compliance, but sleep efficiency improved on the second diagnostic night and an extra titration study may be necessary for some patients, especially those with only one diagnostic night.

Cited by 6 publications

References 44 publications

Unmasking of Periodic Limb Movements With the Resolution of Obstructive Sleep Apnea During Continuous Positive Airway Pressure Application

Unmasking of Periodic Limb Movements With the Resolution of Obstructive Sleep Apnea During Continuous Positive Airway Pressure Application

Factors that influence CPAP adherence: an overview

A Comparison of Two Nights of Ambulatory Sleep Testing in Arrhythmia Patients

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