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Clinical guidelines for the manual titration of PAP in OSA patients published in JCSM

WESTCHESTER, Ill. Positive airway pressure (PAP) devices are used to treat patients with sleep-related breathing disorders, including obstructive sleep apnea (OSA). Following the diagnosis of OSA, a polysomnogram (PSG), also known as an overnight sleep test, is conducted, during which PAP is adjusted (titrated) to determine the amount of pressure needed to free the upper airway and prevent it from being blocked by the collapsed tissue in the back of the throat. Continuous positive airway pressure (CPAP) and bi-level positive airway pressure (BPAP) are the two forms of PAP that are manually titrated during a PSG to determine the optimal amount of pressure for subsequent nightly usage. Clinical guidelines published in the April 15 issue of the Journal of Clinical Sleep Medicine (JCSM) offer recommendations for conducting CPAP and BPAP titrations in patients with OSA. These guidelines, aimed at increasing the effectiveness of PAP devices in the treatment of OSA, are expected to have a positive impact on the practice of sleep medicine, patient treatment outcomes, and health care costs.

The guidelines were developed by a PAP Titration Task Force of the American Academy of Sleep Medicine (AASM).

Among the major recommendations offered by the Task Force include making sure all potential PAP titration candidates receive adequate PAP education, hands-on demonstration, careful mask fitting, and acclimatization prior to titration. The recommendations also include increasing CPAP until the following obstructive respiratory events are eliminated or the recommended maximum CPAP is reached: apneas, hypopneas, respiratory effort-related arousals, and snoring. Further, limits are established on how much water the CPAP device should have at the outset for both pediatric and adult OSA patients, as well as how much water should be added to the CPAP device throughout the course of the night and what conditions should be met in order for the CPAP level to be increased.

It is anticipated that these guidelines will provide a more standardized method of titrating OSA patients with positive airway pressure, and will assist sleep laboratories in the recognition of what comprises an acceptable vs. unacceptable titration, said Clete A. Kushida, MD, PhD, of Stanford University Medical Center, Task Force chair.

OSA is a sleep-related breathing disorder that causes your body to stop breathing during sleep. OSA occurs when the tissue in the back of the throat collapses and blocks the airway. This keeps air from getting into the lungs. It is estimated that four percent of men and two percent of women have OSA, and millions more remain undiagnosed.

On average, most adults need seven to eight hours of nightly sleep to feel alert and well-rested.

The AASM offers the following tips on how to get a good nights sleep:

  • Follow a consistent bedtime routine.

  • Establish a relaxing setting at bedtime.

  • Get a full nights sleep every night.

  • Avoid foods or drinks that contain caffeine, as well as any medicine that has a stimulant, prior to bedtime.

  • Do not bring your worries to bed with you.

  • Do not go to bed hungry, but dont eat a big meal before bedtime either.

  • Avoid any rigorous exercise within six hours of your bedtime.

  • Make your bedroom quiet, dark and a little bit cool.

  • Get up at the same time every morning.

First introduced as a treatment option for sleep apnea in 1981, CPAP is the most common and effective treatment for OSA. CPAP provides a steady stream of pressurized air to patients through a mask that they wear during sleep. This airflow keeps the airway open, preventing the pauses in breathing that characterize sleep apnea and restoring normal oxygen levels.


Contact: Jim Arcuri
American Academy of Sleep Medicine

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