title: Comparison of manual titration and automatic titration based on forced oscillation technique, flow and snoring in obstructive sleep apnea.
abstract: BACKGROUND
  Continuous positive airway pressure (CPAP) treatment in obstructive sleep apnea syndrome (OSAS) requires pressure titration usually performed during attended in-hospital polysomnography. This manual titration procedure is not well standardized. The aim of the study was to ascertain whether a new automatic titration device is as effective as standard manual titration in determining constant CPAP pressure.
  
  
  METHODS
  We included 38 patients with a newly diagnosed OSAS. Participants were randomly assigned to attended in-laboratory manual titration and automatic titration in two consecutive nights. Fixed CPAP pressure was set at the optimal pressure determined during the second night. The follow-up period was 6 weeks. Main outcomes were apnea/hypopnea index (AHI) and Epworth sleepiness scale (ESS).
  
  
  RESULTS
  AHI (manual: baseline 40.5+/-21.5/h vs. treatment 6.4+/-3.3/h (p<0.001); automatic: 53.3+/-28.1/h vs. 7.8+/-3.3/h (p<0.001)) and ESS (manual: 11.3+/-4.7 vs. 8.8+/-5.1 (ns); automatic: 11.5+/-5.6 vs. 7.0+/-3.8 (p<0.05)) showed a similar improvement in both groups. Pressure recommendation by the device and the technician, although not statistically different (8.7+/-2.9 vs. 9.0+/-3.3 mbar), corresponded only in 50% of the patients.
  
  
  CONCLUSIONS
  Automatic titration effectively predicts constant CPAP pressure for long-term treatment when performed during an attended polysomnography. Careful evaluation of raw data and polysomnography recording is mandatory before choosing a fixed CPAP pressure after automatic titration.
authors.affiliation: Bethanien Hospital Solingen, Clinic for Pneumology and Allergology, Center for Sleep Medicine and Respiratory Care, Institute for Pneumology at the University Witten/Herdecke, D-42699 Solingen, Germany. galetke@klinik-bethanien.de
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Galetke
authors.forename: Winfried J
authors.initials: WJ
authors.lastname: Randerath
authors.forename: Sven
authors.initials: S
authors.lastname: Stieglitz
authors.forename: Cordula
authors.initials: C
authors.lastname: Laumanns
authors.forename: Norbert
authors.initials: N
authors.lastname: Anduleit
authors.forename: Kerstin
authors.initials: K
authors.lastname: Richter
authors.forename: Thorsten
authors.initials: T
authors.lastname: Schäfer
mesh_terms: D000328:Adult; D045422:Continuous Positive Airway Pressure / Q000295:instrumentation / Q000379:methods* / Q000592:standards*; D018592:Cross-Over Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017286:Polysomnography; D011312:Pressure; D012015:Reference Standards; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis / Q000628:therapy*