title: The need for pressure changes in CPAP therapy 2-3 months after initial treatment: a prospective trial in 905 patients with sleep-disordered breathing.
abstract: OBJECTIVE
  The aim of the study was to investigate the need for pressure change in patients with sleep-disordered breathing (SDB) several weeks after therapy initiation. We prospectively studied 905 consecutive patients (740 men and 165 women) with SDB and therapeutic intervention with continuous positive airway pressure (CPAP)/bilevel PAP.
  
  
  METHODS
  Several weeks after therapy initiation, patients were restudied for control, and pressure was optimized if it was necessary. The differences in CPAP pressure from initial treatment and control night were assessed. Anthropometric data, polysomnography data, Epworth sleepiness scale, and Berlin questionnaire scores were correlated to pressure differences from the first and control titration nights.
  
  
  RESULTS
  Pressure change was needed in 511 patients (58.2%). Pressure increase was more frequent than pressure reduction (41.7% vs. 11.7%). Mean pressure increase in CPAP was 1.3 mbar, and mean decrease, 1.6 mbar. In the bilevel PAP group, the mean increase in inspiratory pressure was 1.2 mbar, and in expiratory pressure, 0.8 mbar; the mean decrease in inspiratory pressure was 1.9 mbar, and in expiratory pressure, 1.4 mbar. No correlation was found between anthropometric data, sleep efficacy, the amount of rapid eye movement sleep per night, or questionnaire scores and pressure change.
  
  
  CONCLUSIONS
  Our results show that pressure changes are necessary in the majority of patients several weeks after therapy initiation. Therefore, re-evaluation of therapy pressure is useful.
authors.affiliation: Hermann Buhl Institute for Hypoxia and Sleep Medicine Research, Paracelsus Medical University, Salzburg, Ghersburgstr. 9, 83043, Bad Aibling, Germany. nikinetzer@yahoo.com
authors.forename: Nikolaus C
authors.initials: NC
authors.lastname: Netzer
authors.forename: János
authors.initials: J
authors.lastname: Juhász
authors.forename: Markus
authors.initials: M
authors.lastname: Hofmann
authors.forename: Kathrin
authors.initials: K
authors.lastname: Hohl
authors.forename: Kingman P
authors.initials: KP
authors.lastname: Strohl
authors.forename: Thomas E A H
authors.initials: TE
authors.lastname: Küpper
mesh_terms: D000328:Adult; D000368:Aged; D000399:Air Pressure; D045422:Continuous Positive Airway Pressure / Q000295:instrumentation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005858:Germany; D006801:Humans; D008134:Long-Term Care; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D017286:Polysomnography; D011446:Prospective Studies; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D010100:Oxygen