Manual Titration of Positive Airway Pressure in Patients with Obstructive Sleep Apnea

Positive airway pressure ( PAP) devices are used to treat patients who have sleep-related breathing disorders including obstructive sleep apnea. After a patient is diagnosed with obstructive sleep apnea, the current standard of practice involves performing attended polysomnography, during which positive airway pressure is adjusted throughout the recording period to determine the optimal pressure for maintaining upper airway patency. Continuous positive airway pressure ( CPAP) and bilevel positive airway pressure ( BPAP) represent the two most common forms of PAP that are titrated manually during polysomnography to determine the single fixed pressure of CPAP, or the fixed inspiratory and expiratory PAPs of BPAP for subsequent nightly usage in the home. I recently cochaired the PAP Titration Task Force of the American Academy of Sleep Medicine, which reviewed the available literature on PAP titration protocols and strategies and, based on this analysis and expert consensus, developed recommendations for conducting CPAP and BPAP titrations. This article serves to review the task force recommendations and to provide a practical approach to using selected recommendations in the course of laboratory titration of PAP.