Telemetric CPAP titration at home in patients with sleep apnea-hypopnea syndrome.
BACKGROUND
Home continuous positive airway pressure (CPAP) titration with automatic devices is not possible in a non-negligible percentage of patients with sleep apnea-hypopnea syndrome (SAHS).


OBJECTIVE
To test the feasibility of a novel telemetric system for home CPAP titration.


METHODS
One-night home CPAP titration was carried out on 20 SAHS patients (56±3 years; BMI=35±2 kg/m²). A telemetric unit, based on the conventional GPRS mobile phone network and connected to a commercial CPAP device, allowed the hospital technician to monitor flow, pressure and air leaks by remote control and titrate CPAP (elimination of apneas, hypopneas, flow limitation and snoring) in real time. After 1 week, a full hospital polysomnography was performed while the patient was subjected to the value of CPAP that was previously titrated at home via telemetry.


RESULTS
The home-titrated CPAP systematically improved patients' breathing: the apnea-hypopnea index and percentage of sleep time with arterial oxygen saturation below 90% were reduced from 58.1±5.1 to 3.8±0.6 events/h and from 19.8±1.1% to 4.4±0.7%, respectively. This CPAP value (9.15±0.47 cmH₂O) was virtually the same as the pressure that optimized breathing during hospital polysomnography (9.20±0.41 cmH₂O; mean difference: 0.02 cmH₂O, limits of agreement:±1.00 cmH₂O).


CONCLUSIONS
This pilot study shows that a simple telemetric system, requiring neither a special telemedicine network nor any infrastructure in the patient's home, made it possible to perform effective remote CPAP titration on SAHS patients.
TBMLab, Dipartimento di Bioingegneria, Politecnico di Milano, Milano, Italy.
Raffaele
R
Dellacà
Josep M
JM
Montserrat
Leonardo
L
Govoni
Antonio
A
Pedotti
Daniel
D
Navajas
Ramon
R
Farré
D045422:Continuous Positive Airway Pressure / Q000379:methods*; D005240:Feasibility Studies; D006801:Humans; D008875:Middle Aged; D010045:Outpatients; D010865:Pilot Projects; D019095:Point-of-Care Systems; D017286:Polysomnography; D012720:Severity of Illness Index; D012891:Sleep Apnea Syndromes / Q000628:therapy*; D017216:Telemedicine / Q000295:instrumentation* / Q000379:methods*; D013689:Telephone