UNATTENDED CONTINUOUS POSITIVE AIRWAY PRESSURE TITRATION - CLINICAL RELEVANCE AND CARDIORESPIRATORY HAZARDS OF THE METHOD

The high cost of in-laboratory sleep studies and the insufficiency of available nights in most sleep laboratories has prompted clinical tria ls in an attempt to find an effective and safe method for continuous p ositive airway pressure (CPAP) titration in the unsupervised home envi ronment. Earlier publications focused on the effectiveness of this new method but did not indicate the potential hazard and the selection cr iteria of patients. We accomplished a prospective study to evaluate a machine-controlled CPAP titration method in an unselected group of 21 patients with obstructive sleep apnea (OSA) requiring CPAP therapy. Un attended CPAP titrations were completed in the sleep laboratory, follo wed by conventional CPAP titration night. The CPAP levels assessed thr ough automatic titrations showed strong agreement with those from the control nights. Fifteen patients had no pathologic cardiorespiratory e vents during machine-controlled titration. Undesirable cardiorespirato ry complications developed in six patients with underlying cardiorespi ratory disorder. Two patients had to stop the procedure. Two patients needed a reset of the actual pressure to baseline because of central a pneas and one patient because of high-grade arrhythmia. The machine-co ntrolled CPAP titration enabled reliable assessment of an effective pr essure and appeared to be safe in selected patients with OSA. However, because the method caused significant adverse effects in some patient s, we recommend that unattended CPAP titration not be attempted in pat ients with underlying cardiorespiratory disease.