Comparison of two in-laboratory titration methods to determine effective pressure levels in patients with obstructive sleep apnoea
Open accessAbstract
BACKGROUND: Treatment of the sleep apnoea/hypopnoea syndrome with nasal continuous positive airway pressure (CPAP) conventionally requires a titration procedure in a sleep laboratory. The upper airway has a hysteresis phenomenon which accounts for a decrease in the effective positive pressure level once an initial effective pressure setting has been reached. The aim of this study was to quantify the difference in the initial and final effective pressure settings when the titration sleep study takes into account these possible changes in the effective pressure level. METHODS: Eighty five patients completed the study. During a titration sleep study the pressure was increased by 1 cm H2O in a stepwise fashion until obstructive respiratory events disappeared (effective pressure 1, Peff(1)). The pressure level was then decreased by increments of 1 cm H2O until breathing abnormalities reappeared. At this time pressure was re-increased by increments of 1 cm H(2)O to normalise breathing (Peff(2)). RESULTS: The mean (SD) value of Peff(1) was 9.5 (2.6) cm H2O. The pressure was then reduced during 0.5 (0.6) hours to reach the minimal pressure (7.0 (2.0) cm H2O). The pressure obtained after a downward titration had to be re-increased in 79 patients, the Peff(2) level being significantly lower than Peff(1) (8.9 (2.8) cm H2O, p = 0.0002), mean difference 0.6 (1.5) cm H2O (95% confidence interval 0.29 to 0.93). CONCLUSION: Attempts to decrease the positive pressure level during conventional determination of the effective pressure level allow a significant decrease in the pressure setting. This should be taken into account in each patient who requires an in-laboratory manual CPAP titration procedure.
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Split-night titration is not significantly different from full-night titration in subjective sleepiness or adherence over time.
“Split-night titration, where the first couple of hours of the PSG are for diagnostic purposes and the remainder of the study involves PAP titration, compared to a fullnight titration, is not significantly different in terms of outcomes such as subjective sleepiness or adherence over time.1081–1083”
From International Consensus Statement on Obstructive Sleep Apnea (2023) · cites this paper as [1081]
The Discussion (page not specified) says split-night studies may allow too little time for the paper’s pressure-titration procedure, but it does not compare split-night with full-night titration on subjective sleepiness or adherence over time. Searches for those outcomes and for a split-night/full-night comparison found no passage addressing the claimed outcomes. (LLM, conf=0.74)
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- Authors
- Bureau, M. P.
- Affiliations
- Institut universitaire de cardiologie et de pneumologie de Québec (CA)
- Corresponding author
- Bureau, M P
- Venue
- Thorax
- Publisher
- BMJ
- Published
- 2000-09-01
- Volume
- 55
- Issue
- 9
- Pages
- 741-745
- ISSN
- 0040-6376 (ISSN-L)
- PMC
- PMC1745846
- OpenAlex
- W2061602644
- Semantic Scholar
- 6707232d98e66177afe9cb82efe8de015dd7cc8d
- Cited by
- 23
- References
- 33
- Citations by year
- 2026: 1 · 2025: 2 · 2022: 1 · 2020: 1 · 2013: 2 · 2012: 1
- FWCI
- 0.41
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Thorax (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Physiology (medical) › Obstructive Sleep Apnea Research
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Respiratory Support and Mechanisms
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Keywords
- obstructive sleep apnea, CPAP titration, nasal continuous positive airway pressure, sleep apnea-hypopnea syndrome
- MeSH terms
- Adult, Aged, Female, Humans, Male, Middle Aged, Positive-Pressure Respiration, Prospective Studies, Sleep Apnea Syndromes
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