Comparison between the use of APAP and manual titration during split night polysomnography for diagnosis and treatment of OSA

Abstract

Introduction Continuous positive airway pressure (CPAP) remains the gold standard treatment for obstructive sleep apnea (OSA). CPAP titration can be done using manual titration or using autotitrating continuous positive airway pressure (APAP) devices. Moreover, CPAP titration can be done using full-night or split-night protocol. The aim of the study was to compare between the use of APAP and manual titration to determine the needed CPAP pressure during split-night polysomnography for diagnosis and treatment of OSA. Patients and methods A total of 100 patients with severe OSA were enrolled after exclusion of patients with heart failure or respiratory failure. After diagnostic polysomnography, patients were divided into two groups: group 1 was offered manual CPAP titration and group 2 was offered APAP titration. The time for CPAP titration was at least 4 h in both groups. Results Both groups were matched regarding age, sex, BMI, sleep parameters, and apnea–hypopnea index (44.52±7.81/h in group 1 and 42.66±9.68/h in group 2 with no statistical significance). After CPAP titration, apnea–hypopnea index was significantly improved in both groups. The time needed to reach the therapeutic pressure was significantly lower in group 2 than in group 1. Moreover, attended technician was needed only in group 1. Conclusion The use of APAP was equal to manual titration in this group of patients with severe OSA, with decreased cost and lesser time to reach the therapeutic pressure. Large multicenter trials are needed to modify the guidelines in view of using APAP in split-night protocol for diagnosis and treatment of OSA.