CPAP Titration Pressure in Split-Night, Full-Night, and Home Auto-Titration: A Prospective Comparative Analysis of Patients With Moderate to Severe Obstructive Sleep Apnea

Purpose: This prospective study aimed to compare titration pressures obtained using three methods-full-night titration (FN-T), splitnight titration (SN-T), and home auto-titration (HA-T)- in patients with moderate to severe obstructive sleep apnea (OSA). Additionally, factors contributing to pressure differences relative to FN-T were investigated. Methods: SN-T was performed on 74 patients suspected of having OSA. Those diagnosed with moderate to severe OSA who completed SN-T underwent HA-T for 2-3 weeks. FN-T was then performed on patients who adhered to HA-T for at least 70% of prescribed nights. Ultimately, 29 patients met the inclusion criteria. Titration pressures from SN-T (SN-TP), HA-T (mean pressure [HA-TPm] and 90th percentile pressure [HA-TP90]), and FN-T (FN-TP) were compared using the Wilcoxon signed-rank test. Patients were classified into pressure disparity and non-disparity groups based on differences between FN-TP and the other methods. Logistic regression analyses were performed to identify factors associated with pressure differences. Baseline characteristics in subgroup analyses were compared using independent t-tests or Mann-Whitney tests for continuous variables and Fisher's exact tests for categorical variables. Results: The titration pressures for SN-TP, FN-TP, HA-TP90, and HA-TPm were 8, 9, 9.6, and 8.1 cm H2O, respectively. All pressures correlated significantly with FN-TP (p < 0.05). HA-TP90 was significantly higher than FN-TP (p < 0.05), while FN-TP was higher than SN-TP (p < 0.05), with similar trends observed at the individual level. Nasal septal deviation (odds ratio 16.63, p = 0.018) and high apnea-hypopnea index (odds ratio 1.06, p = 0.027) were identified as predictors of pressure differences. Conclusion: This study is the first to directly compare multiple titration pressures to standard FN-TP in the same patients. SN-T and HA-T are reliable alternatives to FN-T in moderate to severe OSA, though predictors of significant pressure variance require careful consideration.