Clinical Guidelines For The Manual Titration Of PAP In OSA Patients Published In JCSM

Main Category: Sleep / Sleep Disorders / Insomnia
Article Date: 16 Apr 2008 - 7:00 PDT

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Positive airway pressure (PAP) devices are used to treat patients with sleep-related breathing disorders, including obstructive sleep apnea (OSA). Following the diagnosis of OSA, a polysomnogram (PSG), also known as an overnight sleep test, is conducted, during which PAP is adjusted ("titrated") to determine the amount of pressure needed to free the upper airway and prevent it from being blocked by the collapsed tissue in the back of the throat. Continuous positive airway pressure (CPAP) and bi-level positive airway pressure (BPAP) are the two forms of PAP that are manually titrated during a PSG to determine the optimal amount of pressure for subsequent nightly usage. Clinical guidelines published in the April 15 issue of the Journal of Clinical Sleep Medicine (JCSM) offer recommendations for conducting CPAP and BPAP titrations in patients with OSA. These guidelines, aimed at increasing the effectiveness of PAP devices in the treatment of OSA, are expected to have a positive impact on the practice of sleep medicine, patient treatment outcomes, and health care costs.

The guidelines were developed by a PAP Titration Task Force of the American Academy of Sleep Medicine (AASM).

Among the major recommendations offered by the Task Force include making sure all potential PAP titration candidates receive adequate PAP education, hands-on demonstration, careful mask fitting, and acclimatization prior to titration. The recommendations also include increasing CPAP until the following obstructive respiratory events are eliminated or the recommended maximum CPAP is reached: apneas, hypopneas, respiratory effort-related arousals, and snoring. Further, limits are established on how much water the CPAP device should have at the outset for both pediatric and adult OSA patients, as well as how much water should be added to the CPAP device throughout the course of the night and what conditions should be met in order for the CPAP level to be increased.

"It is anticipated that these guidelines will provide a more standardized method of titrating OSA patients with positive airway pressure, and will assist sleep laboratories in the recognition of what comprises an acceptable vs. unacceptable titration," said Clete A. Kushida, MD, PhD, of Stanford University Medical Center, Task Force chair.

OSA is a sleep-related breathing disorder that causes your body to stop breathing during sleep. OSA occurs when the tissue in the back of the throat collapses and blocks the airway. This keeps air from getting into the lungs. It is estimated that four percent of men and two percent of women have OSA, and millions more remain undiagnosed.

On average, most adults need seven to eight hours of nightly sleep to feel alert and well-rested.

The AASM offers the following tips on how to get a good night's sleep:

• Follow a consistent bedtime routine.
  
  
• Establish a relaxing setting at bedtime.
  
  
• Get a full night's sleep every night.
  
  
• Avoid foods or drinks that contain caffeine, as well as any medicine that has a stimulant, prior to bedtime.
  
  
• Do not bring your worries to bed with you.
  
  
• Do not go to bed hungry, but don't eat a big meal before bedtime either.
  
  
• Avoid any rigorous exercise within six hours of your bedtime.
  
  
• Make your bedroom quiet, dark and a little bit cool.
  
  
• Get up at the same time every morning.

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Article adapted by Medical News Today from original press release.
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CPAP Central (SleepEducation.com), a Web site created by the AASM, provides the public with comprehensive, accurate and reliable information about CPAP. CPAP Central includes expanded information about OSA and CPAP, including how OSA is diagnosed, the function of CPAP, the benefits of CPAP and an overview of what to expect when beginning CPAP, the position of experts on CPAP, and tools for success. CPAP Central also features an interactive slide set that educates the public about the warning signs of OSA.

Those who think they might have OSA, or another sleep disorder, are urged to consult with their primary care physician or a sleep specialist.

More information about OSA is available from the AASM at http://www.sleepeducation.com/cpapcentral

JCSM is the official publication of the AASM. It contains published papers related to the clinical practice of sleep medicine, including original manuscripts such as clinical trials, clinical reviews, clinical commentary and debate, medical economic/practice perspectives, case series and novel/interesting case reports.

SleepEducation.com, a patient education Web site created by the AASM, provides information about various sleep disorders, the forms of treatment available, recent news on the topic of sleep, sleep studies that have been conducted and a listing of sleep facilities.

Article, entitled, "Clinical Guidelines for the Manual Titration of Positive Airway Pressure in Patients with Obstructive Sleep Apnea."

SLEEP 2008, the 22nd Annual Meeting of the Associated Professional Sleep Societies and the world's largest annual gathering of sleep scientists and sleep medicine professionals, will take place in Baltimore, Maryland, from June 9-12, 2008. SLEEP 2008 will bring together an international body of 5,000 leading researchers and clinicians, who will present and discuss over 1,100 new findings and medical developments related to sleep and sleep disorders. More details, including the program schedule and a list of invited lecturers, are available at http://www.sleepmeeting.org/.

Source: Jim Arcuri
American Academy of Sleep Medicine