Lara C. Pullen, PhD

November 07, 2013

CHICAGO — Fixed air pressure can be optimized for 97% of patients with obstructive sleep apnea in as few as 4 days, according to the results of a new study. This compares favorably with the 7 days typically used to determine optimal continuous positive airway pressure (CPAP) treatment settings.

"This will improve time to prescription in an individual patient and time to treatment in those waiting for titration by improving access and reducing wait times," Mark Fenton, MD, from the University of Saskatchewan in Saskatoon, Canada, told Medscape Medical News.

Dr. Fenton presented the results here at CHEST 2013.

Auto-CPAP is a common method for determining optimal pressure settings. This is typically done using the 95th percentile CPAP pressure. The challenge becomes determining the duration of time required. This ranges widely in the scientific literature, from 1 to 7 days of titration.

The Sleep Disorders Centre in Saskatchewan currently uses a 7-day protocol to determine CPAP settings. This study was designed to determine if it was possible to shorten the protocol, Dr. Fenton explained.

His team evaluated data from 562 patients who underwent auto-CPAP titration for 7 days.

Patients were screened by a specialist for sleep disorders and diagnosed with obstructive sleep apnea using polysomnogram. They were each given an apnea-hypopnea index score by a registered technician using American Academy of Sleep Medicine criteria, which was reviewed manually by a sleep specialist.

The results of this study will allow us to create efficiencies in our program.

The sleep center educated patients about mask options and then fitted them with the product of their choice. The ResMed S8 AutoSet II CPAP system is the most common mask at the center, but the ResMed S8 AutoSet Vantage is also used.

Researchers assessed CPAP prescription, index score, medium leak time, and average use time, and compared results at 1 to 6 days with those at 7 days. They used 2 models of stabilization — a change of no more than 0.5 cmH₂O and a change no more than 1.0 cmH₂O — to evaluate the results.

Many patients (42%) did not experience a pressure change of more than 0.5 cmH₂O after day 1, and the majority of patients (84%) did not experience a pressure change of more than 0.5 cmH₂O after day 4.

A total of 74% of patients did not experience a pressure change of more than 1.0 cmH₂O after day 1, and 97% had less than a 1.0 cmH₂O change in CPAP pressure at 4 days of titration.

Dr. Fenton reported that a small percentage of patients did not stabilize even after 7 days. This lack of stabilization appears to be related to higher leak and inadequate use.

"The results of this study will allow us to create efficiencies in our program," he said.

"The study results are more relevant in Canada because they are trying to crank people through the system," session moderator Richard Waldhorn, MD, from Georgetown University in Chevy Chase, Maryland, told Medscape Medical News. "In many places in the United States, you give patients the CPAP machine and they just keep it."

Dr. Fenton and Dr. Waldhorn have disclosed no relevant financial relationships.

CHEST 2013: American College of Chest Physicians Annual Meeting. Presented October 27, 2013.


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