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Weak acids and bases do not undergo dissociation completely, and titrations between these two are rarely studied. When such studies are performed, say, for the titration of a weak acid with a weak base, the titration curve plots the change in pH as a function of the volume of base added. Take the titration of acetic acid with ammonia, for instance. During the titration, these two species form ammonium acetate and water, but the pH change is slow and gradual.
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The treatment for acute respiratory failure varies based on factors like the underlying cause, overall health, and severity. A collaborative healthcare team is essential for early detection, often through arterial blood gas analysis. Identifying the cause is the primary goal, with treatment strategies adjusted for ventilation/perfusion (V/Q) mismatch, shunting, or diffusion impairment.
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Practical and rapidly-implemented parameters for assessing APAP titration failure.

Sezgi Şahin Duyar1,2, Selma Fırat3, Türkan Kara3

  • 1Sleep Disorders Center, University of Health Sciences Atatürk Chest Diseases and Thoracic Surgery Education and Research Hospital, 06280, Keçiören, Ankara, Turkey. drsezgisahin@gmail.com.

Sleep & Breathing = Schlaf & Atmung
|March 21, 2020
PubMed
Summary

Minimum SpO2 below 86% predicts autoadjusting positive airway pressure (APAP) titration failure in obstructive sleep apnea patients. Deep sleep and REM sleep latencies can supplement this prediction, guiding the need for advanced PAP devices.

Keywords:
Auto-adjusting positive airway pressure titrationMinimum oxygen saturationObstructive sleep apnea syndromeREM latencyTitration failurenREM3 latency

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Area of Science:

  • Sleep Medicine
  • Respiratory Physiology
  • Medical Technology

Background:

  • Obstructive sleep apnea syndrome (OSAS) affects millions globally.
  • Autoadjusting positive airway pressure (APAP) is a common treatment.
  • Predicting APAP titration failure is crucial for effective treatment.

Purpose of the Study:

  • To evaluate simple polysomnographic parameters for predicting APAP titration failure.
  • To identify key indicators for treatment success in OSAS patients.

Main Methods:

  • Retrospective analysis of 1470 OSAS patients undergoing APAP titration.
  • Comparison of 22 patients with titration failure against 44 matched controls.
  • Analysis of deep sleep (nREM3) latency, REM sleep latency, and minimum SpO2.

Main Results:

  • Significant differences in nREM3 latency (p=0.004), REM latency (p=0.008), and minimum SpO2 (p<0.001) between groups.
  • Thresholds identified: nREM3 latency >40 min, REM latency >135 min, minimum SpO2 <86%.
  • Minimum SpO2 <86% showed 86.4% sensitivity for predicting failure.

Conclusions:

  • Minimum SpO2 <86% is a practical indicator for APAP titration failure.
  • nREM3 and REM latencies serve as supplementary predictors for advanced PAP device needs.