Clinical Guidelines for the Manual Titration of Positive Airway Pressure in Patients with Obstructive Sleep Apnea
Positive Airway Pressure Titration Task Force of the AmericanAcademy of Sleep Medicine
Task Force Members: Clete A. Kushida, M.D., Ph.D., RPSGT (Chair)1; Alejandro Chediak, M.D. (Vice-Chair)2; Richard B. Berry, M.D.3; Lee K. Brown, M.D.4; David Gozal, M.D.5;Conrad Iber, M.D.6; Sairam Parthasarathy, M.D.7; Stuart F. Quan, M.D.8; James A. Rowley, M.D.9 Stanford University Center of Excellence for Sleep Disorders, Stanford, CA; 2Sleep Disorders Center, MountSinai Medical Center, Miami Beach, FL; 3Division of Pulmonary, Critical Care, and Sleep Medicine, University of Florida, Gainesville, FL; 4University of New Mexico Health Sciences Center, Albuquerque,NM; 5Department of Pediatrics, Division of Pediatric Sleep Medicine, University of Louisville, Louisville, KY; 6University of Minnesota, Minneapolis, MN; 7SAVAHCS and University of Arizona, Tucson, AZ;8Division of Sleep Medicine, Harvard Medical School, Boston, MA; 9Department of Internal Medicine, Division of Pulmonary, Allergy, Critical Care & Sleep Medicine, Wayne State University School ofMedicine, Detroit, MI
Summary: Positive airway pressure (PAP) devices are used to treat patients with sleep related breathing disorders (SRBDs), including obstructive sleep apnea (OSA). After apatient is diagnosed with OSA, the current standard of practice involves performing attended polysomnography (PSG), during which positive airway pressure is adjusted throughout the recording period todetermine the optimal pressure for maintaining upper airway patency. Continuous positive airway pressure (CPAP) and bilevel positive airway pressure (BPAP) represent the two forms of PAP that aremanually titrated during PSG to determine the single fixed pressure of CPAP or the fixed inspiratory and expiratory positive airway pressures (IPAP and EPAP, respectively) of BPAP for subsequent nightly...