Different Continuous Positive Airway Pressure Titration Modalities in Obstructive Sleep Apnea Syndrome Patients

Background: Patients with obstructive sleep apnea syndrome are mainly treated with continuous positive airway pressure. Polysomnography-guided full-night manual titration is the gold standard for continuous positive airway pressure titration, but it is cost-, time-, and effort-consuming. Alternative ways of titration are easier with less cost, time, and effort. In the era of the COVID-19 pandemic, the need to establish more safe strategies is increased. Aim: To choose a rapid, efficient, simple, and safe method with less effort and cost in the measurement of a suitable level of positive airway pressure in the management of obstructive sleep apnea syndrome. Methods: This study enrolled 48 adult patients who had been diagnosed with obstructive sleep apnea syndrome at our sleep unit and were candidates for treatment with continuous positive airway pressure according to AASM 2008 after exclusion of other sleep-related breathing disorders. All patients underwent both laboratory full-night manual titration and auto-titration (by Prisma20A of WEINMANN medical technology, Germany). Manual titration pressure and P95 of auto-titration were obtained and compared with calculated pressures by five predictive formulas (Miljeteig and Hoffstein, Series, Stradling, Loredo, and Lee). Results: Patients included in the study were 25 females (52.1%) and 23 males (47.9%) with a mean +/- SD of age of 49.98 +/- 10.36 years. Mean +/- SD of manual pressure was 10.44 +/- 2.49 cmH(2)O, P95 was 10.16 +/- 2.64 cmH(2)O, and calculated pressures by different equations were: Miljeteig and Hoffstein, 8.53 +/- 2.03; Series, 11.40 +/- 1.81; Stradling, 9.68 +/- 1.65; Loredo, 9.90 +/- 1.79; and Lee, 10.61 +/- 2.68 cmH(2)O. No significant differences were reported between manual pressure and pressures of auto-titration with Series, Stradling, Loredo, and Lee equations (p=0.112, 0.09, 0.212, 0.213, and 0.657, respectively). Conclusion: Auto-titration can be used as an effective alternative to manual titration with less cost and effort and is more comfortable to patients. Predictive formulas can be used instead of standard and auto-titration especially in resource-limited facilities and in