ATTENDED HOME TITRATION OF NASAL CONTINUOUS POSITIVE AIRWAY PRESSURE THERAPY FOR OBSTRUCTIVE SLEEP-APNEA

Nasal continuous positive airway pressure (CPAP) therapy for obstructive sleep apnea (OSA) is usually titrated in a sleep laboratory with full polysomnographic monitoring until apneas, nonapneic desaturation, snoring, and micro-arousals are eliminated. This titration is sometimes done in the second half of the diagnostic sleep study or commonly on a separate second full night in the sleep laboratory. We performed NCPAP titration in the home in 17 patients with OSA previously documented by full polysomnography. Nasal CPAP was titrated at night in the patient's home by a registered nurse or polysomnography technician monitoring real-time recordings of heart rate, thoracic impedance, oxygen saturation, and pressure at the nasal mask on a four-channel recorder (EdenTec, Eden Prairie, Minn). Recordings of the nasal CPAP titration night were reviewed later by a physician. Apneas, hypopneas, and snoring were successfully eliminated in all patients. Mean nasal CPAP pressure was 10.3 +/- 3.2 cm H2O. At the time of a follow-up interview, 13 of 17 patients continued to be compliant with nasal (PAP therapy. The mean duration of therapy was 13.4 +/- 11.7 months with 7.23 mean hours of use for 6.76 nights per week. This compliance compares favorably with long-term home nasal CPAP compliance previously reported in patients titrated in our sleep laboratory. Home nasal CPAP titration resulted in about a $600 savings per patient.