M P Bureau1, F Sériès. 1. Centre de Recherche, Hôpital Laval, Institut Universitaire de Cardiologie et de Pneumologie de l'Université Laval, Sainte-Foy, Québec G1V 4G5, Canada.
Abstract
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.
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.
Authors: Nikolaus C Netzer; János Juhász; Markus Hofmann; Kathrin Hohl; Kingman P Strohl; Thomas E A H Küpper Journal: Sleep Breath Date: 2010-03-04 Impact factor: 2.816
Authors: Rogerio Santos Silva; Viviane Truksinas; Luciane de Mello-Fujita; Eveli Truksinas; Leiko Kawata Zanin; Maria Christina Ribeiro Pinto; Marta Sevilha de Paula; Robert P Skomro; Lia Rita A Bittencourt; Sergio Tufik Journal: Sleep Breath Date: 2008-03 Impact factor: 2.816
Authors: Clete A Kushida; Alejandro Chediak; Richard B Berry; Lee K Brown; David Gozal; Conrad Iber; Sairam Parthasarathy; Stuart F Quan; James A Rowley Journal: J Clin Sleep Med Date: 2008-04-15 Impact factor: 4.062