title: Control of OSA during automatic positive airway pressure titration in a clinical case series: predictors and accuracy of device download data.
abstract: OBJECTIVE
  To investigate the factors associated with physiologic control of obstructive sleep apnea (OSA) during automatic positive airway pressure (APAP) titration in a clinical series. To also assess the usefulness of apnea-hypopnea index (AHI) data downloaded from the APAP device (Dev AHI).
  
  
  METHODS
  Retrospective review of a consecutive series of patients with OSA who underwent APAP titration (Autoset Spirit, ResMed, Bella Vista, New South Wales, Australia ) with simultaneous polysomnographic (PSG) monitoring in the sleep laboratory.
  
  
  METHODS
  Tertiary sleep clinic.
  
  
  METHODS
  There were 190 consecutive patients with OSA referred for APAP titration.
  
  
  RESULTS
  There were 58% of patients who achieved optimal or good control of OSA (titration PSG AHI < 10, or at least 50% reduction in AHI if diagnostic AHI < 15/hr) during APAP titration. The independent predictors of titration PSG AHI were a history of cardiac disease and elevated central apnea and arousal indices during the diagnostic study. Although the median and interquartile range (IQR) AHI from the device (7.0, 3.9-11.6 events/hr) was only slightly less than the PSG AHI (7.8, 3.9-14.4 events/hr, P = 0.04) during titration, case-by-case agreement between the two measures was poor (chi-square < 0.001).
  
  
  CONCLUSIONS
  In a clinical sample control of OSA during APAP titration is often poor, and close clinical follow-up is particularly needed in patients with a history of cardiac disease or with high arousal or central apnea indices on the diagnostic study. Device AHI does not reliably assess control during APAP titration, and PSG assessment may be required if clinical response to treatment is poor. The findings relate to the ResMed AutoSet device and may not apply to other devices.
authors.affiliation: Department of Respiratory and Sleep Medicine, The Canberra Hospital, Woden ACT, Australia.
authors.forename: Hsin-Chia Carol
authors.initials: HC
authors.lastname: Huang
authors.forename: David R
authors.initials: DR
authors.lastname: Hillman
authors.forename: Nigel
authors.initials: N
authors.lastname: McArdle
mesh_terms: D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017286:Polysomnography / Q000379:methods; D011175:Positive-Pressure Respiration / Q000295:instrumentation* / Q000379:methods; D015203:Reproducibility of Results; D012189:Retrospective Studies; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis / Q000628:therapy*; D016896:Treatment Outcome