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

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.