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Optimal Fixed Pressure CPAP Can Be Determined Using a 4 Day Auto-CPAP Titration Protocol
October 2013, Vol 144, No. 4_MeetingAbstracts Sleep Disorders | October 2013
Optimal Fixed Pressure CPAP Can Be Determined Using a 4 Day Auto-CPAP Titration Protocol Mark Fenton, MD; Brian Graham, PhD; John Reid, MD; Robert Skomro, MD; John Gjevre, MD; David Cotton, MD; Sam Stewart, MA; Arshviny Ollegasagrem University of Saskatchewan, Saskatoon, SK, Canada Chest. 2013;144(4_MeetingAbstracts):981A. doi:10.1378/chest.1703159
Abstract SESSION TITLE: CPAP for OSA SESSION TYPE: Original Investigation Slide PRESENTED ON: Sunday, October 27, 2013 at 03:00 PM - 04:00 PM PURPOSE: Auto-CPAP is an accepted method of determining optimal fixed pressure CPAP settings, however, the duration required for accurate titration is unknown. Previous studies have used varying lengths of titration (1 day to several weeks). We wanted to determine if optimal fixed pressure CPAP settings using 95th percentile (p95) CPAP pressure can be determined in less than 7 days (our current protocol). METHODS: We retrospectively examined data on patients undergoing auto-CPAP (Resmed S8) titration in our Sleep Disorders Centre. A 7-day titration period was used to determine p95 for prescription of fixed pressure CPAP. We collected p95, median leak, average usage time and residual apnea-hypopnea index (AHI) for 1, 2, 3, 4, 5 and 6 days, which were compared to 7 days. Age, sex, BMI, and pretreatment AHI were also collected. We examined 2 models of stabilization - p95 change of ≤0.5 cmH2O and p95 change ≤1.0 cmH2O. RESULTS: A total of 562 patients (362 males, 200 females) had data available. Average age was 55 years, average BMI 34, and average pre-treatment AHI 35.2. Using a cutoff of ≤0.5 cmH2O p95 did not change in 42% after day 1 - increasing to 56%, 71% and 84% after the 2nd 3rd and 4th days. In 74% of cases p95 did not change >1.0 cmH2O after the first day - increasing to 84%, 93% and 97% after the 2nd 3rd and 4th days. After 4 days 89.3% had a p95 within 0-0.5 cmH2O of their day 7 p95, and an additional 8.5% of patients had a value within 0.5-1 cmH2O. There was a significant relationship between usage rates (<4 hours vs ≥4 hours) and stabilization (p<0.01) but not with residual AHI, median leak, or BMI. CONCLUSIONS: Optimal fixed pressure CPAP settings could be determined in 4 days in over 97% of our cases. CLINICAL IMPLICATIONS: Our results may allow rationalization of titration protocols for determination of fixed pressure CPAP settings. In our centre, shortening the duration to 4 days will improve access to treatment.
DISCLOSURE: The following authors have nothing to disclose: Mark Fenton, Brian Graham, John Reid, Robert Skomro, John Gjevre, David Cotton, Sam Stewart, Arshviny Ollegasagrem No Product/Research Disclosure Information
Optimal Fixed Pressure CPAP Can Be Determined Using a 4 Day Auto-CPAP Titration Protocol Mark Fenton, MD; Brian Graham, PhD; John Reid, MD; Robert Skomro, MD; John Gjevre, MD; David Cotton, MD; Sam Stewart, MA; Arshviny Ollegasagrem University of Saskatchewan, Saskatoon, SK, Canada Chest. 2013;144(4_MeetingAbstracts):981A. doi:10.1378/chest.1703159
Abstract SESSION TITLE: CPAP for OSA SESSION TYPE: Original Investigation Slide PRESENTED ON: Sunday, October 27, 2013 at 03:00 PM - 04:00 PM PURPOSE: Auto-CPAP is an accepted method of determining optimal fixed pressure CPAP settings, however, the duration required for accurate titration is unknown. Previous studies have used varying lengths of titration (1 day to several weeks). We wanted to determine if optimal fixed pressure CPAP settings using 95th percentile (p95) CPAP pressure can be determined in less than 7 days (our current protocol). METHODS: We retrospectively examined data on patients undergoing auto-CPAP (Resmed S8) titration in our Sleep Disorders Centre. A 7-day titration period was used to determine p95 for prescription of fixed pressure CPAP. We collected p95, median leak, average usage time and residual apnea-hypopnea index (AHI) for 1, 2, 3, 4, 5 and 6 days, which were compared to 7 days. Age, sex, BMI, and pretreatment AHI were also collected. We examined 2 models of stabilization - p95 change of ≤0.5 cmH2O and p95 change ≤1.0 cmH2O. RESULTS: A total of 562 patients (362 males, 200 females) had data available. Average age was 55 years, average BMI 34, and average pre-treatment AHI 35.2. Using a cutoff of ≤0.5 cmH2O p95 did not change in 42% after day 1 - increasing to 56%, 71% and 84% after the 2nd 3rd and 4th days. In 74% of cases p95 did not change >1.0 cmH2O after the first day - increasing to 84%, 93% and 97% after the 2nd 3rd and 4th days. After 4 days 89.3% had a p95 within 0-0.5 cmH2O of their day 7 p95, and an additional 8.5% of patients had a value within 0.5-1 cmH2O. There was a significant relationship between usage rates (<4 hours vs ≥4 hours) and stabilization (p<0.01) but not with residual AHI, median leak, or BMI. CONCLUSIONS: Optimal fixed pressure CPAP settings could be determined in 4 days in over 97% of our cases. CLINICAL IMPLICATIONS: Our results may allow rationalization of titration protocols for determination of fixed pressure CPAP settings. In our centre, shortening the duration to 4 days will improve access to treatment.
DISCLOSURE: The following authors have nothing to disclose: Mark Fenton, Brian Graham, John Reid, Robert Skomro, John Gjevre, David Cotton, Sam Stewart, Arshviny Ollegasagrem No Product/Research Disclosure Information