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

BackgroundContinuous 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.MethodsWe 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).ResultsAHI (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.ConclusionsAutomatic 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.