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Clinical Investigations: Sleep/Breathing: ArticlesCPAP Titration for Sleep Apnea Using a Split-Night Protocol
Section snippets
Subjects
We selected 107 patients who had sleep-disordered breathing evaluated in our clinical laboratory. The patients were 90 men and 17 women (aged 52.3±12.1 [mean±SD] years; body mass index, 34.4±8.2 kg/m2). All of them were referred to our laboratory because of excessive daytime sleepiness or snoring. Patients were not screened and had not had polysomnography prior to being in this study, and were newly diagnosed as having OSA or UARS. Twenty-three patients who had periodic limb movements in sleep
Results
Results in the 107 patients are shown in Table 1. The differences in TRT and TST simply reflect the split-night and second-night protocol. The SEI was significantly lower during the split-night CPAP period than during baseline and second-night CPAP. There were also significant differences between baseline and the split-night CPAP, and between baseline and the second night CPAP for percent stage 2, percent stage REM, Ar-I, AHI, percent TST below 90% SaO2, and percent TST below 80% SaO2. However,
Discussion
Our results show that there is a significant reduction in Ar-I, AHI, percent TST below 90% SaO2, and percent TST below 80% SaO2 during both the split-night CPAP and the second-night CPAP compared with baseline; however, there were no significant differences between the split-night CPAP and the second-night CPAP. These results suggest that a split-night protocol is as effective as a second night in reducing apnea and hypopnea, improving oxygenation, and reducing arousals. The improvements during
Conclusion
A split-night protocol may be sufficient to obtain an effective CPAP pressure for most patients with obstructive sleep apnea, especially if AHI>20. For patients with AHK20, if symptoms are not improving, reevaluation may be necessary to confirm the effectiveness of treatment.
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2009, Sleep MedicineCitation Excerpt :Moreover, inadequate titration may prolong patients’ stay in the sleep laboratory and consequently lengthen waiting lists. In a few studies split night protocols, i.e., initial diagnostic PSG followed by CPAP titration during PSG in the same night, have been successfully performed to reduce in-hospital treatment time [20,21], but are recommended only in selective patients [1]. Prediction of CPAP pressure using a formula has been evaluated as an alternative approach in randomized controlled studies.
Positive Airway Pressure in the Treatment of Sleep Apnea-Hypopnea
2009, Sleep Disorders Medicine