Nap-titration: An effective alternative for continuous positive airway pressure titration - 12/08/11

Doi : 10.1016/j.rmed.2005.07.014

Aarnoud Hoekema ^a,^⁎ , Boudewijn Stegenga ^a, Johannes G. van der Aa ^b, Aafke F. Meinesz ^b,^c, Johannes H. van der Hoeven ^d, Peter J. Wijkstra ^b,^c
^a Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, P.O. Box 30.001, 9700 RB Groningen, The Netherlands
^b Department of Home Mechanical Ventilation, University Medical Center Groningen, University of Groningen, Hanzeplein 1, P.O. Box 30.001, 9700 RB Groningen, The Netherlands
^c Department of Pulmonary Diseases, University Medical Center Groningen, University of Groningen, Hanzeplein 1, P.O. Box 30.001, 9700 RB Groningen, The Netherlands
^d Department of Clinical Neurophysiology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, P.O. Box 30.001, 9700 RB Groningen, The Netherlands

Corresponding author. Tel.: +31503613840; fax: +31503611136.

Summary

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.

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Keywords : Positive-pressure ventilation, Sleep apnea syndromes, Nap-titration

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Polysomnographic evaluation

Questionnaire evaluation

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Vol 100 - N° 4

P. 705-713 - avril 2006 Retour au numéro

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Nap-titration: An effective alternative for continuous positive airway pressure titration - 12/08/11

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