Am. J. Respir. Crit. Care Med., Vol 154, No. 2, 08 1996, 359-365.
Unattended continuous positive airway pressure titration. Clinical relevance and cardiorespiratory hazards of the method
J Juhasz, J Schillen, A Urbigkeit, T Ploch, T Penzel and JH Peter
Zentrum fur Innere Medizin, Philipps-Universitat, Medizinische Poliklinik, Schlafmedizinisches Labor, Marburg, Germany.
The high cost of in-laboratory sleep studies and the insufficiency of
available nights in most sleep laboratories has prompted clinical trials in
an attempt to find an effective and safe method for continuous positive
airway pressure (CPAP) titration in the unsupervised home environment.
Earlier publications focused on the effectiveness of this new method but
did not indicate the potential hazard and the selection criteria 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.
Unattended CPAP titrations were completed in the sleep laboratory, followed
by conventional CPAP titration night. The CPAP levels assessed through
automatic titrations showed strong agreement with those from the control
nights. Fifteen patients had no pathologic cardiorespiratory events during
machine- controlled titration. Undesirable cardiorespiratory complications
developed in six patients with underlying cardiorespiratory disorder. Two
patients had to stop the procedure. Two patients needed a reset of the
actual pressure to baseline because of central apneas and one patient
because of high-grade arrhythmia. The machine-controlled CPAP titration
enabled reliable assessment of an effective pressure and appeared to be
safe in selected patients with OSA. However, because the method caused
significant adverse effects in some patients, we recommend that unattended
CPAP titration not be attempted in patients with underlying
cardiorespiratory disease.
