APAP titration in patients with mild to moderate OSAS and periodic limb movement syndrome

1) to evaluate automatic positive airway pressure (APAP) titration in a partially attended setting; 2) to verify whether APAP performance depends on the apnea-hypopnea and periodic limb movement indexes (PLMI).

65 CPAP naïve subjects with a sleep disorder of breathing and daytime sleepiness underwent a standard polysomnography (first night), APAP titration (second night, partially attended), and a standard polysomnography using continuous positive airway pressure (CPAP) at the effective pressure (Peff) established from the APAP titration (third night) in a sleep disorder laboratory in a 400-bed community hospital. We examined the apnea-hypopnea index (AHI), sleep stages, arousals induced by respiratory events (RESPa) and PLM (PLMa), and oxygen saturation during the first and third nights on CPAP at the Peff. Patients were divided into three groups according to their AHI and PLMI.

At the Peff defined using APAP on the third night, the mean AHI dropped from 29.6 +/- 21.8 to 3.1 +/- 3.4, and the RESPa index from 16.5 +/- 16.2 to 1.7 +/- 2.6. No differences emerged in sleep stages or spontaneous arousals (first vs third night). Overall, 92% of the patients met the standard for an acceptable outcome of positive pressure titration. Baseline AHI and PLMI did not affect the outcome of titration.

In patients with mild to moderate OSAS and PLMS, APAP titration enables the optimal fixed pressure for CPAP home therapy to be determined in at least 90% of patients.