Clinical guidelines for the manual titration of PAP in OSA patients publish...( WESTCHESTER Ill. Positive airway pr...),Health

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
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