Chest
Volume 107, Issue 1, January 1995, Pages 62-66
Journal home page for Chest

Clinical Investigations: Sleep/Breathing: Articles
CPAP Titration for Sleep Apnea Using a Split-Night Protocol

https://doi.org/10.1378/chest.107.1.62Get rights and content

We studied 107 patients with sleep-disordered breathing to confirm the effectiveness of continuous positive airway pressure (CPAP) titration using a split-night protocol. Patients spent two consecutive nights in our laboratory with complete polysomnography. On the first night, we applied a split-night protocol; the first half of the night was used as a baseline (B), and after a diagnosis was made, CPAP was applied during the second half of the night (SN). On the second night (2N), patients spent the entire night on CPAP to confirm the effectiveness of CPAP treatment. The SN and 2N both revealed a significant reduction in arousal index (37.8±27.9 on B, 13.2±12.1 on SN, 11.4±8.0 on 2N, values are mean±SD, p<0.001), apnea hypopnea index (AHI) (23.6±26.3/h on B, 3.0±3.7/h on SN, 2.4±2.6/h on 2N, p<0.001), percent total sleep time below 90% SaO2 (21.0±27.2% on B, 8.2±13.8% on SN, 4.9±10.2% on 2N, p<0.001), and percent total sleep time below 80% SaO2 (1.1±3.8% on B, 0.0±0.1% on SN, 0.1±0.5% on 2N, p<0.001). There were no significant differences between the SN and the 2N for these measurements. Final CPAP pressure was significantly lower at the end of the SN when compared with the 2N (8.8±2.7 cm H2O on SN, vs 10.3±2.8 cm H2O on 2N, p<0.001). When patients were divided into three groups (AHI <20, n=69; 20<AHI<40, n=18; AHI>40, n=20), the final CPAP pressure was different only in the group with AHI<20 (8.1±2.3 cm H2O on SN, 9.6±2.3 cm H2O on 2N, p<0.001). We conclude that a split-night protocol may be sufficient to determine the effective CPAP pressure, especially in patients with an AHI>20.

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.

References (10)

There are more references available in the full text version of this article.

Cited by (104)

  • Diagnostic algorithm for sleep-related breathing disorders

    2023, Encyclopedia of Sleep and Circadian Rhythms: Volume 1-6, Second Edition
  • CPAP and BPAP titration

    2010, Sleep Medicine Clinics
  • Positive Airway Pressure in the Treatment of Sleep Apnea-Hypopnea

    2009, Sleep Disorders Medicine: Basic Science, Technical Considerations, and Clinical Aspects: Third Edition
  • Comparison of manual titration and automatic titration based on forced oscillation technique, flow and snoring in obstructive sleep apnea

    2009, Sleep Medicine
    Citation 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.

View all citing articles on Scopus
View full text