title: Multinight recording and analysis of continuous positive airway pressure airflow in the home for titration and management of sleep disordered breathing.
abstract: OBJECTIVE
  The authors examined magnitude/variability of residual sleep disordered breathing (SDB) at pressures around the therapeutic continuous positive airway pressure (CPAP), and described a multinight approach to CPAP titration/retitration consisting of recording airflow and summarizing SDB over multiple nights at multiple pressures and choosing an optimal pressure from these summarized data.
  
  
  METHODS
  Prospective, single-center nonblinded study.
  
  
  METHODS
  Ten female/18 male patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) (respiratory disturbance index [RDI] 67/h), 17 newly-initiated, 11 chronic CPAP users.
  
  
  METHODS
  A custom CPAP device (Fisher & Paykel Healthcare) recording airflow and pre-programmed to vary CPAP between 2-3 cm H2O below and 1-2 cm H2O above prescription pressure as determined by a full laboratory titration.
  
  
  RESULTS
  Airflow and pressure continuously recorded for multiple nights (15.9 ± 5.1 nights) at four to seven different pressures in each patient. SDB events manually scored from the airflow as apnea (airflow reduction > 90%), hypopnea (airflow reduction > 30% lasting 10 to 120 sec with inspira-tory flow limitation [IFL]) and runs of sustained IFL > 2 min identified. RDI = (apnea + hypopnea)/total sleep time calculated for each night and an obstruction index, including sustained IFL, also was calculated. PressureMultinight was obtained for each patient from multiple nights of data using two mathematical techniques. Night-to-night variability of SDB indices was low in some patients and significant in others. PressureMultinight could be determined in 17 of 28 patients and was similar to the in-laboratory pressure.
  
  
  CONCLUSIONS
  This study showed that recording multiple nights of CPAP airflow in the home and analyzing these data for residual SDB provided useful information, including the possibility of determining a therapeutic prescription for fixed CPAP in most patients and identification of others with significant physiologic variability of SDB.
authors.affiliation: NYU School of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, New York, NY, USA.
authors.forename: Cynthia Y
authors.initials: CY
authors.lastname: Callahan
authors.forename: Robert G
authors.initials: RG
authors.lastname: Norman
authors.forename: Zachary
authors.initials: Z
authors.lastname: Taxin
authors.forename: Anne M
authors.initials: AM
authors.lastname: Mooney
authors.forename: David M
authors.initials: DM
authors.lastname: Rapoport
authors.forename: Indu
authors.initials: I
authors.lastname: Ayappa
mesh_terms: D000328:Adult; D000368:Aged; D045422:Continuous Positive Airway Pressure / Q000379:methods* / Q000706:statistics & numerical data; D019468:Disease Management; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000706:statistics & numerical data*; D017286:Polysomnography / Q000379:methods* / Q000706:statistics & numerical data; D011446:Prospective Studies; D015203:Reproducibility of Results; D012891:Sleep Apnea Syndromes / Q000628:therapy*
keywords: CPAP Titration; General; Obstructive Sleep Apnea; Severity Metric; Sleep Disordered Breathing; Treatment Algorithm
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