Nap-titration: an effective alternative for continuous positive airway pressure titration.

When treating Obstructive Sleep Apnea-Hypopnea Syndrome (OSAHS) several alternatives for standard (manual) continuous positive airway pressure (CPAP) titration are feasible. A practical alternative is titration without polysomnography during an afternoon nap (Nap-titration). The aim of the present study was to assess whether Nap-titration is appropriate for effective titration of CPAP. Following Nap-titration 24 eligible OSAHS patients started conventional CPAP therapy. The outcome of Nap-titration was verified after 2 weeks with CPAP pressure adjustments being performed in case of persisting OSAHS symptomatology. Polysomnography and a questionnaire evaluation were performed at baseline and 8 weeks after Nap-titration. Following Nap-titration 15 patients did not require pressure changes while in 9 patients' CPAP pressure was raised due to persisting OSAHS symptomatology. Control polysomnography after 8 weeks showed successful CPAP titration (Apnea-Hypopnea Index <5) in 23 out of 24 patients. A pressure raise following polysomnography was indicated in 1 patient only. In addition, significant improvements were found in OSAHS symptomatology and quality of life. This study shows that in 96% of OSAHS patients' successful CPAP titration is attained following Nap-titration whether or not supplemented by pressure adjustments. Therefore, Nap-titration with an adequate follow-up appears an appropriate procedure for the effective titration of CPAP.