Sleep Technologists Research Articles

Oral Presentations

Journal of Sleep ResearchVolume 20, Issue s1 p. 17-26 Free Access Oral Presentations First published: 30 September 2011 https://doi.org/10.1111/j.1365-2869.2011.00952.xAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Volume20, Issues1Special Issue: Sleep DownUnder 2011, sleep and the city, Australasian Sleep Association and Australasian Sleep Technologists Association, 23rd Annual Scientific Meeting, Sydney Convention Centre, 27-29 October 2011October 2011Pages 17-26 RelatedInformation

Ubiquitous Health Monitoring System for Diagnosis of Sleep Apnea With Zigbee Network and Wireless LAN

The Greek word “apnea” literally means “without breath.” The three types of apnea are obstructive, central, and mixed. Obstructive is the most common type. Despite the difference in the root cause of the three types of apnea, people with untreated sleep apnea stop breathing repeatedly during their sleep, sometimes hundreds of times during the night and often for 1 min or longer. Sleep apnea can cause high blood pressure and other cardiovascular diseases, memory problems, weight gain, impotency, and headaches. Sleep apnea may be responsible for job impairment and motor vehicle accidents. Apart from the physical health risks, sleep apnea can lead to social problems when left undiagnosed or untreated such as a high amount of unnecessary health care cost. Sleep disorder is diagnosed with polysomnography, an overnight sleep study, by monitoring electrical activity of brain, heart, eye movement, muscle activity, breathing pattern, and other physiological signals. Because polysomnography requires overnight monitoring by a sleep technologist with full sleep staging, polysomnography is expensive, inconvenient, time consuming, and labor intensive. Although some systems provide home based diagnosis, most systems record the sleep data in a memory card. The patient must send the memory card to a medical center through the mail or internet. The real-time monitoring is not performed and a patient can experience life threatening episodes by not receiving proper feedback from a medical center or a physician. We propose a wireless health monitoring system to diagnose sleep apnea, which enables the global monitoring of biomedical signals. A patient does not need hospitalization and can be diagnosed and receive feedback at home. The system supports monitoring five different biomedical signals to diagnose sleep apnea: electrocardiogram with dry electrodes (no gel), body position, nasal airflow, abdomen/chest efforts and oxygen saturation. The system consists of three units: a wireless transmitter, a wireless receiver, and a monitoring unit. A wireless transmitter unit sends the measured signals from sensors to a receiver unit with Zigbee communication. The receiver unit, which has two wireless modules, Zigbee and Wi-Fi, receives signals from the transmitter unit and retransmits signals to the remote monitoring system with Zigbee and Wi-Fi communication, respectively. By using both the Zigbee network and wireless LAN, the system can achieve low power consumption in a local monitoring area with the feature of the Zigbee standard. The system also provides wide data coverage and easily extends its sensor network to the Internet with the Wi-Fi standard. The features of the system and the results of the continuous monitoring of vital signals are presented.

A method to screen obstructive sleep apnea using multi-variable non-intrusive measurements

Obstructive sleep apnea (OSA) is a serious sleep disorder. The current standard OSA diagnosis method is polysomnography (PSG) testing. PSG requires an overnight hospital stay while physically connected to 10–15 channels of measurement. PSG is expensive, inconvenient and requires the extensive involvement of a sleep technologist. As such, it is not suitable for community screening. OSA is a widespread disease and more than 80% of sufferers remain undiagnosed. Simplified, unattended and cheap OSA screening methods are urgently needed. Snoring is commonly associated with OSA but is not fully utilized in clinical diagnosis. Snoring contains pseudo-periodic packets of energy that produce characteristic vibrating sounds familiar to humans. In this paper, we propose a multi-feature vector that represents pitch information, formant information, a measure of periodic structure existence in snore episodes and the neck circumference of the subject to characterize OSA condition. Snore features were estimated from snore signals recorded in a sleep laboratory. The multi-feature vector was applied to a neural network for OSA/non-OSA classification and K-fold cross-validated using a random sub-sampling technique. We also propose a simple method to remove a specific class of background interference. Our method resulted in a sensitivity of 91 ± 6% and a specificity of 89 ± 5% for test data for AHITHRESHOLD = 15 for a database consisting of 51 subjects. This method has the potential as a non-intrusive, unattended technique to screen OSA using snore sound as the primary signal.

Nocturnal moaning and groaning—catathrenia or nocturnal vocalizations

Descriptions of nocturnal vocalizations, including catathrenia, are few. We undertook a study at our center on patients diagnosed with catathrenia, to evaluate the characteristic features of these events and their response to continuous positive airway pressure (CPAP) treatment. Retrospective study of patients with a diagnosis of catathrenia who had an overnight polysomnogram (PSG) and available synchronized audio video recordings (to confirm the presence of moaning and groaning), at our center between January 2007 and May 2010. Ten patients were included in the analysis. Three (30%) patients presented with the chief complaint of expiratory noises during sleep. The other moaning/groaning sounds were incidental findings noted by the sleep technologist and/or the sleep physician. The number of moaning/groaning events during PSG varied between 2 and 343 per patient with sound duration ranging from 0.4 to 21.4s. Moaning/groaning events during exhalation (1,026 episodes) were separated into typical catathrenia events (as per the International Classification of Sleep Disorders, 2nd edition [ICSD-2] definition) and atypical/nocturnal vocalization events (moaning/groaning events that did not meet the ICSD-2 criteria). Typical catathrenia events (5% or 52/1,026) were experienced by five of the ten patients and had mean exhalation duration of 14.97 ± 5.13s (range 5.8-24s) with a mean sound duration of 8.47 ± 5.97s (range 2-21.4s). The typical and atypical events occurred predominantly in NREM sleep. Six of the ten patients had associated sleep-disordered breathing and four underwent CPAP titration. All four patients had significantly fewer events of moaning/groaning (mean reduction was 75.8 ± 26.2%) with CPAP. New and unique features were identified in our series of patients diagnosed with catathrenia. Though all events had the characteristic moaning and groaning sound during exhalation, only a small percentage (5%) met the catathrenia definition as outlined in ICSD-2. Do we label the atypical events as part of the spectrum of nocturnal vocalizations or consider them as catathrenia by redefining the criteria? CPAP appeared to be a reasonable treatment option.

Sleep medicine in Saudi Arabia: Current problems and future challenges.

Sleep medicine is a relatively new specialty in the medical community. The practice of sleep medicine in Saudi Arabia (KSA) began in the mid to late nineties. Since its inception, the specialty has grown, and the number of specialists has increased. Nevertheless, sleep medicine is still underdeveloped in the KSA, particularly in the areas of clinical service, education, training and research. Based on available data, it appears that sleep disorders are prevalent among Saudis, and the demand for sleep medicine service is expected to rise significantly in the near future. A number of obstacles have been defined that hinder the progress of the specialty, including a lack of trained technicians, specialists and funding. Awareness about sleep disorders and their serious consequences is low among health care workers, health care authorities, insurance companies and the general public. A major challenge for the future is penetrating the educational system at all levels to demonstrate the high prevalence and serious consequences of sleep disorders. To attain adequate numbers of staff and facilities, the education and training of health care professionals at the level of sleep medicine specialists and sleep technologists is another important challenge that faces the specialty. This review discusses the current position of sleep medicine as a specialty in the KSA and the expected challenges of the future. In addition, it will guide clinicians interested in setting up new sleep medicine services in the KSA or other developing countries through the potential obstacles that may face them in this endeavor.

S1-2 The clinical and polysomnographic features relevance of idiopathic REM sleep behavior disorders

For a long time has Rechtschaffen and Kales (R&K) manual been considered as the sleep community’s bible for sleep scoring. This manual was published in 1968, intending to achieve the consensus among a small number of sleep researchers. However, it survived following 40 years as the essential manual for clinicians and sleep technologists due to its powerful utility. One of the characteristics of R&K scoring criteria is that it is based on epoch-by-epoch sleep staging. Later in 1970s when the concept of sleep apnea syndrome (SAS) was introduced, scoring respiratory events became essential. With the recognition of SAS, sleep gained the status as a clinical subject, which involved treating patients for having a good sleep. As a result, scoring criteria of EEG arousals and periodic leg movements were developed by the American Sleep Disorders Association in early 1990s for more extensive evaluation of sleep quality and sleep-related phenomena. These criteria basically formulated the rules to count defined events, and were incorporated in sleep staging of the R&K manual, which made it difficult for beginners to master them without proper on-the-job training. In 2007, American Academy of Sleep Medicine (AASM) completed a new manual for the scoring of sleep and associated events including cardiac, movement, and respiratory events. Although there has been a controversy on the use of this manual, it should be valued as the first attempt to unite all the measurements necessary for sleep scoring through reviewing numerous articles in pursuit of validity or reliability of measures. However, one thing we should bear in mind is that the AASM manual was developed with the purpose to provide a guideline for AASM accredited sleep disorders centers. Therefore, we should not be bound by it for scientific purpose, and make every effort to introduce more refined methods in the future.

Sleep technologist performance: a call for standardization and performance feedback

In their article in Sleep and Breathing, Surani and colleagues describe a sleep laboratory questionnaire implemented as a quality assurance instrument to provide standardized feedback to the sleep lab technologist. The authors accurately identify the lack of recognized standardized mechanisms to provide feedback to the sleep technologist with the goal of improving upon the quality of care being provided in the sleep laboratory setting. This is an area of importance, in particular, given the burgeoning growth in the number of sleep centers and therefore attendant sleep studies being performed. There are currently no standardized means of assessing the technologist-related performance of sleep study data acquisition that has been put forth by the American Academy of Sleep Medicine. By the same token, global technologist performance quality measures are not formally incorporated or mandated in the sleep laboratory accreditation process.

Standardization of quality assurance for sleep technologist: a model

Since the last decade, there has been a tremendous growth of sleep centers in the US to meet the increasing need of diagnosing and treating sleep disorders. However, this unregulated growth has resulted in tremendous variance in the quality of sleep centers across the nation. The American Academy of Sleep Medicine, in an attempt to provide a benchmark standard, has introduced a voluntary accreditation process, part of which involves assessment of technical quality parameters. However, measuring technical quality is not easy. We undertook a study to determine if the implementation of point system and schematic feedback on technologist performance can result in improvement and tracking of their performance. We randomly reviewed 100 charts from the preimplementation phase as control and 1,739 charts from the post implementation of the point system phase as study group. There was a statistically significant difference in the score among technologist between the control and study groups with the average being 75 +/- 4.12 and 87.53 +/- 0.91, respectively, with a p value being 0.0001. Evaluating the performance of the sleep technologist can be a way to track and monitor their performance in a standardized way and to identify weakness at an earlier stage. We present a system, which we have developed and implemented at our sleep center, as a possible model of assessing and subsequently standardizing technical quality for polysomnography.

Response to Marcus, CL. Letter to the Editor

The authors of the Positive Airway Pressure Titration Task Force of the American Academy of Sleep Medicine (AASM) thank Dr. Carole Marcus for her thoughtful review1 of the AASM’s recently published clinical guidelines paper in the Journal of Clinical Sleep Medicine.2 It is stated in the clinical guidelines paper that these recommendations should not be con sidered inclusive of all proper methods of care or exclusive of other methods of care reasonably directed to obtaining the same results and that the ultimate judgment regarding the propriety of any specific care must be made by the clinician in light of the indi vidual circumstances presented by the patient. It is also mentioned that sleep technologists and clinicians should combine their experience and judgment with the application of these recommendations to attain the best possible titration in any given patient. The recommendations in the paper were developed by our multidisciplinary task force (including those who have titrated pediatric patients with PAP) using a formal consensus process. Consensus recommendations are a maximum CPAP of 15 cm H2O (Recommendation 4.2.1.3) and a maximum IPAP of 20 cm H2O (Recommendation 4.3.1.4) for patients 15 cm H2O were switched to BPAP.3 The task force recognizes that there will always be exceptions to any guidelines, and this is the reason that the task force indicated that these are recommendations and that they were obtained by consensus. Dr. Marcus also indicated that the time duration is not clearly stated in the recommendation for an increase in pressure level in response to an obstructive apnea, i.e., whether the time duration is one hour or all night (Recommendation 4.2.2.2). She correctly points out that differences in time duration over which the apnea occurs could result in the apnea-hypopnea index (AHI) to fall on either side of an AHI of 1 per hour (the upper limit of the normative value in children). The underpinnings for our recommendation are based on the fact that the titration is done “real-time,” and the technologist cannot predict whether the obstructive apnea is a solitary or soon to be recurring event. If this obstructive apnea is soon to be a recurrent event, then valuable time available for titration is not wasted by our recommendation to increase the pressure. Alternatively, if it is indeed a solitary event, then our recommendation to increase the pressure by 1 cm H2O will, at worse, result in a treatment pressure that is just 1 cm H2O greater than the optimal pressure. However, for a given sleep state and body position, a 1 cm H2O increment in response to an obstructive apnea may not result in resolution of future hypopneas, RERAs, and unambiguous snoring. It should be noted that the task force also recommends that the pressure increments should not occur at intervals shorter than 5 min in order to allow for transient events that occur around sleep-wake transitions to resolve on their own without pressure increments (Recommendation 4.2.2.1). This time-based recommendation will abrogate unwarranted pressure increments in response to such transient respiratory events. She also expresses concern that our recommendation to increase pressure in response to an obstructive apnea in children <12 years of age may not be the best option for a child requiring higher pressure levels who is having a hard time tolerating CPAP in the laboratory. But, once again, we believe that the judgment by the technologist and clinician regarding the titration must be made in light of the individual circumstances presented by the patient. Additionally, there is always the option of “down” titration (Recommendation 4.2.2.8) that could be subsequently conducted during the night by technologists and clinicians who have such concerns. The task force very much appreciates the opportunity to respond to these comments and we welcome further commentary.

Clinical Guidelines for the Manual Titration of Positive Airway Pressure in Patients with Obstructive Sleep Apnea

Positive airway pressure (PAP) devices are used to treat patients with sleep related breathing disorders (SRBDs), including obstructive sleep apnea (OSA). After a patient is diagnosed with OSA, the current standard of practice involves performing attended polysomnography (PSG), during which positive airway pressure is adjusted throughout the recording period to determine the optimal pressure for maintaining upper airway patency. Continuous positive airway pressure (CPAP) and bilevel positive airway pressure (BPAP) represent the two forms of PAP that are manually titrated during PSG to determine the single fixed pressure of CPAP or the fixed inspiratory and expiratory positive airway pressures (IPAP and EPAP, respectively) of BPAP for subsequent nightly usage. A PAP Titration Task Force of the American Academy of Sleep Medicine reviewed the available literature. Based on this review, the Task Force developed these recommendations for conducting CPAP and BPAP titrations. Major recommendations are as follows: (1) All potential PAP titration candidates should receive adequate PAP education, hands-on demonstration, careful mask fitting, and acclimatization prior to titration. (2) CPAP (IPAP and/or EPAP for patients on BPAP) should be increased until the following obstructive respiratory events are eliminated (no specific order) or the recommended maximum CPAP (IPAP for patients on BPAP) is reached: apneas, hypopneas, respiratory effort-related arousals (RERAs), and snoring. (3) The recommended minimum starting CPAP should be 4 cm H2O for pediatric and adult patients, and the recommended minimum starting IPAP and EPAP should be 8 cm H2O and 4 cm H2O, respectively, for pediatric and adult patients on BPAP. (4) The recommended maximum CPAP should be 15 cm H2O (or recommended maximum IPAP of 20 cm H2O if on BPAP) for patients or = 12 years. (5) The recommended minimum IPAP-EPAP differential is 4 cm H2O and the recommended maximum IPAP-EPAP differential is 10 cm H2O (6) CPAP (IPAP and/or EPAP for patients on BPAP depending on the type of event) should be increased by at least 1 cm H2O with an interval no shorter than 5 min, with the goal of eliminating obstructive respiratory events. (7) CPAP (IPAP and EPAP for patients on BPAP) should be increased from any CPAP (or IPAP) level if at least 1 obstructive apnea is observed for patients or = 12 years. (8) CPAP (IPAP for patients on BPAP) should be increased from any CPAP (or IPAP) level if at least 1 hypopnea is observed for patients or = 12 years. (9) CPAP (IPAP for patients on BPAP) should be increased from any CPAP (or IPAP) level if at least 3 RERAs are observed for patients or = 12 years. (10) CPAP (IPAP for patients on BPAP) may be increased from any CPAP (or IPAP) level if at least 1 min of loud or unambiguous snoring is observed for patients or = 12 years. (11) The titration algorithm for split-night CPAP or BPAP titration studies should be identical to that of full-night CPAP or BPAP titration studies, respectively. (12) If the patient is uncomfortable or intolerant of high pressures on CPAP, the patient may be tried on BPAP. If there are continued obstructive respiratory events at 15 cm H2O of CPAP during the titration study, the patient may be switched to BPAP. (13) The pressure of CPAP or BPAP selected for patient use following the titration study should reflect control of the patient's obstructive respiration by a low (preferably 3 hr).

How to Start a Sleep Lab or CenterHow to Start a Sleep Lab or Center. Michael J.Breus PhD, D, ABSM 197p. $395.00 Sleep Center Management Institute: Atlanta, GA.

When taking on an entrepreneurial challenge, it can be exciting to experience both the pleasure and the fear involved in such an adventure. However, unlike starting a small business in your own home or garage, establishing a sleep disorders center requires a full commitment from the very beginning, encompassing everything from leasing or buying the bricks and mortar to choosing equipment and hiring staff. The prospect of having to address these wide-ranging issues and the fear of missing an important detail can be overwhelming. Fortunately, help is out there, most recently in the form of a book entitled How to Start a Sleep Lab or Center. In this new volume, Dr. Michael J. Breus has done an outstanding job in meticulously crafting a detailed guide to the challenging process of establishing a sleep lab or center from scratch.

Multiple sleep latency test and maintenance of wakefulness test.

In addition to overnight polysomnography, there are two special tests with which every sleep technologist should be familiar: the multiple sleep latency test and the maintenance of wakefulness test. These two tests classify excessive daytime sleepiness using objective data. The role of the sleep technologist is to understand and perform an accurate test so that sleep clinicians can use that data in diagnosing and treating their patients. This article provides step-by-step directions for performing these tests.

Monitoring respiration during sleep.

Monitoring of respiration during sleep allows the assessment of physiologic variables that are required to characterize SRBD events. The patency of the upper airway, the pattern of breathing, oxygenation, and ventilation usually can be inferred from simultaneous measurements of airflow, respiratory effort, thoracic volume, and blood gases. As new techniques of respiratory monitoring emerge, the respiratory therapist and sleep technologist must be familiar with the advantages and shortcomings of each modality.

Making Polysomnography More “Child Friendly:” A Family-Centered Care Approach

With the increasing recognition of pediatric sleep disorders, there is a growing demand for pediatric sleep medicine services, including polysomnography. The procedure of polysomnography can be particularly challenging in young children with limited ability to cooperate, especially when they have developmental disabilities or other medical complications. This article describes a family-centered care approach to polysomnography in children that is appropriate in any type of sleep laboratory setting. This approach emphasizes respect for the family, psychological preparation, adaptation of laboratory routines to the needs of the family, substitution of child-friendly terminology for medical jargon, coping strategies for the child and family during the procedure, positioning for comfort, utilization of distraction and medical play, modeling behavior for the parent, and continuous praise and reassurance for the child. In our experience with over 1000 studies in children of all ages with a broad range of comorbidities, implementation of this approach has minimized the burden of the polysomnography for the child, boosted the confidence of the sleep technologist, improved study quality for the diagnostician, and increased patient and family satisfaction.

Abstracts presented at the combined Annual Scientific Meeting of the Australasian Sleep Association and the Australasian Sleep Technologists Association, 2004

Abstracts presented at the combined Annual Scientific Meeting of the Australasian Sleep Association and the Australasian Sleep Technologists Association, 2004

Polysomnographic Technologists–Troubled Waters Ahead?

Free AccessPolysomnographic Technologists–Troubled Waters Ahead? Lawrence J. Epstein, M.D. Lawrence J. Epstein, M.D. Sleep Health Center, Bedford, MA; President-Elect, American Academy of Sleep Medicine Search for more papers by this author Published Online:January 15, 2005https://doi.org/10.5664/jcsm.26328Cited by:2SectionsPDF ShareShare onFacebookTwitterLinkedInRedditEmail ToolsAdd to favoritesDownload CitationsTrack Citations About Previous article Next article FiguresReferencesRelatedDetailsCited by Sleep Medicine Training Across the SpectrumStrohl K Chest, 10.1378/chest.10-0783, Vol. 139, No. 5, (1221-1231), Online publication date: 1-May-2011. The History of PolysomnographyDeak M and Epstein L Sleep Medicine Clinics, 10.1016/j.jsmc.2009.04.001, Vol. 4, No. 3, (313-321), Online publication date: 1-Sep-2009. Volume 01 • Issue 01 • January 15, 2005ISSN (print): 1550-9389ISSN (online): 1550-9397Frequency: Monthly Metrics History Published onlineJanuary 15, 2005 Information© 2005 American Academy of Sleep MedicinePDF download

Efficacy of automated continuous positive airway pressure in children with sleep-related breathing disorders in an attended setting.

The purpose of this study was to evaluate the safety and efficacy of automated continuous positive airway pressure (Auto-CPAP) in children. Sleep-related breathing disorders (SRBDs) include the clinical spectrum of symptomatic chronic snoring, upper airway resistance syndrome, and obstructive sleep apnea. This spectrum occurs in adults and children. Less data are available for children despite recognition of the condition's prevalence. CPAP has been an established treatment for adults and children. Treatment with Auto-CPAP has been available for adults but has not been reported previously in children. A group of 14 children (8 months to 12 years old) was evaluated prospectively with baseline polysomnographic study and CPAP titration performed with Auto-CPAP under sleep technologist supervision. The results demonstrated that Auto-CPAP is sensitive and effective for children with obstructive sleep apnea in an attended setting. There was 1 subject who did not seem to tolerate Auto-CPAP, but when she was switched to conventional CPAP, she did not tolerate that either. In this subject, the mask never fit well. She was excluded from the analysis. All other patients had a decrease in the number of abnormal breathing events during sleep. The respiratory disturbance index decreased from a mean of 12.6 (SD: 12.4) to 2.6 (SD: 2.7) events per hour. The lowest oxygen saturation improved from a mean of 86% (SD: 10.8) to 93.6% (SD: 3.9). We conclude that Auto-CPAP is safe and effective in an attended environment. Auto-CPAP did not eliminate all the abnormal respiratory events. In subjects 1 and 14, the final respiratory index improved but remained >5 events per hour (5.9 and 7.7, respectively). We suspect that this was because of problems with the masks leaking, which illustrates the importance of follow-up and possible need for retitration in some patients. Proper mask fit is essential for successful treatment. Additional work is needed to evaluate its utility in the home setting. This study was designed to evaluate Auto-CPAP titration in an attended environment. It did not indicate information about the effectiveness in an unattended or home setting. We demonstrate that Auto-CPAP is able to detect abnormal breathing events during sleep in children and may provide the necessary pressure to correct these events. Auto-CPAP can be used safely for pressure titration in an attended setting. Auto-CPAP devices from different manufactures are commercially available for adults. These different devices may have different algorithms and sensitivities to detect abnormal breathing episodes. This study was performed with only 1 specific model of Auto-CPAP. Our results should not be extrapolated to other Auto-CPAP devices without empirical confirmation of the devices' ability to detect and correct events in children. Auto-CPAP can be an alternative treatment for SRBDS in the pediatric population. These results allow for speculation of possible applications for Auto-CPAP in children. A potential advantage of Auto-CPAP includes permitting the initiation of treatment while awaiting a standard CPAP titration. The variable pressure response of Auto-CPAP allows for treatment under different situations such as upper airway infections, different sleeping positions, and changes in weight. As the child grows, the amount of positive pressure needed to maintain airway patency may change. Auto-CPAP may be able to adjust to these changing pressure requirements. Auto-CPAP does not eliminate the need for periodic office visits and evaluations of the clinical course.

Abstracts of the combined annual scientific meeting of the Australasian Sleep Association and the Australasian Sleep Technologists Association. Auckland, New Zealand, 10-12 October 2003.

Internal Medicine JournalVolume 34, Issue 3 p. A17-A40 Abstracts presented at the combined Annual Scientific Meeting of the Australasian Sleep Association and the Australasian Sleep Technologists Association, 2003 First published: 25 March 2004 https://doi.org/10.1111/j.1444-0903.2004.abstracts.xAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Volume34, Issue3March 2004Pages A17-A40 RelatedInformation

CPAP compliance in sleep apnea patients with and without laboratory CPAP titration.

Advances in auto-adjusting positive airway pressure technology for obstructive sleep apnea now permit this treatment to be initiated outside of the sleep laboratory environment, bypassing the need for laboratory-based titration studies. Thus far, little research has addressed how such developments may affect compliance to continuous positive airway pressure (CPAP). We tested the effect of laboratory CPAP exposure and technologist support in a retrospective chart review of 98 veterans with obstructive sleep apnea to determine whether patients who received standard laboratory CPAP titration complied better with CPAP than did patients who received no laboratory CPAP titration. Fifty patients underwent standard technician-attended polysomnography (PSG) with CPAP titration, and 48 patients underwent unattended PSG with no laboratory trial of CPAP (first CPAP exposure was at home). Objective CPAP compliance measures were obtained from CPAP units at follow-up visits. Attended-PSG patients wore CPAP significantly longer per night on average (5.0 hours vs 3.9 hours) and tended to wear CPAP on more nights (76.5% vs 64.2%) compared with unattended-PSG patients. These findings suggest that patients' sleep laboratory experience with CPAP and the support and education provided by sleep technologists are important factors in facilitating CPAP compliance.

Board of Registration for Polysomnographic Technologists

Board of Registration for Polysomnographic Technologists