Evaluation of apap parameters in one to three nights titration for final pressure decision-making in a real world clinical setting

PURPOSE: Compare pressure values obtained from APAP titration with the final pressure (PF) selected by the clinician to approximate and optimize as much as possible our OSA patients treatment management. METHODS: Retrospective descriptive study in 114 OSA treated patients. After 2-3 months with empiric CPAP pressure, they underwent 2-3 nights with 2 different APAP devices to help clinicians to decide an APAP pressure according to percentile 95 (P95) and median (Pm) values after visual analysis. We selected 60 patients (30 for each device) meeting the inclusion criteria until our 3 months follow-up consultation when, according to clinical outcomes, final pressure (PF) is established. Data analysis was blind and random, by an experienced and independent sleep physician and how and why the clinicians used the APAP was statistically evaluated, measuring parameters from each device for every patient and combination of nights and comparing them with PF, whose correlation with AHI was also analyzed. RESULTS: We found only significant evidence (p < 0.05) using Pm and Resmed device and considering AHI as a compliance predictive value, but no statistical difference (p > 0.05) performing more than one APAP night. CONCLUSIONS: A single night of APAP titration and use of the median pressure may suffice to determine an optimal fixed CPAP setting in our patients. We discuss limitations including small sample size, exclusion of unstable patients and absence of laboratory PSG comparison and Spanish-specific practice patterns.