(02-02-2014, 12:41 PM)herbm Wrote: Does anyone know where to find (preferably online but at med library, Amazon etc. would be useful too) books/articles/manuals on how a physician should analyze and set the APAP?
I want this for at least two reasons:
1) To learn as much as possible
2) To understand the current training that sleep docs have available
Hi herbm,
I think a good place to start may be to review suggested procedures to be followed during titration studies. These procedures are short, easy to understand and provide insight into how the pressure settings are arrived at.
I think ResMed and Philips Respironics have suggested titration procedures on their web sites (at least they used to), plus introductory educational materials.
I'll see what I can find using google and will add edits below.
Take care,
--- Vaughn
Edits:
(1) Philips Respironics Titration protocol reference guide:
http://sleepapnea.com/downloads/1002159_...fGuide.pdf
(2) ResMed Sleep Lab Titration Guide:
http://www.resmed.com/us/documents/10139...-guide.pdf
(3) American Association of Sleep Technologists titration guidelines:
http://www.aastweb.org/Resources/Guideli...ummary.pdf
(4) The real deal, professional practice guidelines:
American Academy of Sleep Medicine Practice Parameters
http://www.aasmnet.org/Resources/Practic...Update.pdf
http://www.aasmnet.org/Resources/Practic...ate_ET.pdf
http://www.aasmnet.org/practiceparameters.aspx?cid=102
Note: From looking at our own sleep data we know our pressure needs vary hour-to-hour and day-to-day, but the protocol below for simple fixed-pressure CPAP titration, from article (3) above, requires a minimum of only 15 minutes at the titrated pressure as long as some REM sleep is included.
2.2.1 CPAP Titration
Patients < 12 years old
CPAP minimum = 4 cm H2O
CPAP maximum = 20 cm H2O
Patients > 12 years old
CPAP minimum = 4 cm H2O
CPAP maximum = 20 cm H2O
Increase pressure by a minimum of 1 cm H2O with an interval of no less than 5 minutes when you see [any of] the following:
Patients < 12 years old
1 obstructive apnea
1 hypopnea
3 RERAs
1 min. of loud or unambiguous snoring
Patients > 12 years old
2 obstructive apneas
3 hypopneas
5 RERAs
3 min. of loud or unambiguous snoring
You have achieved an optimal titration when you see [all of] the following:
1. The Respiratory Disturbance Index (RDI) is < 5 per hour for a period of at least 15 minutes at the selected pressure and within the manufacturer’s acceptable leak limit.
2. The SpO2 is above 90% at the selected pressure.
3. Supine REM sleep at the selected pressure is not continually interrupted by spontaneous arousals or
awakenings.
You have achieved a good titration when you see [all of] the following:
1. The Respiratory Disturbance Index (RDI) is < 10 per hour (or is reduced by 50% if the baseline RDI was < 15) for a period of at least 15 minutes at the selected pressure and within the manufacturer’s acceptable leak limit.
2. The SpO2 is above 90% at the selected pressure.
3. Supine REM sleep at the selected pressure is not continually interrupted by spontaneous arousals or
awakenings.
You have achieved an adequate titration when you see the following:
1. The Respiratory Disturbance Index (RDI) is NOT < 10 per hour, but the RDI is reduced by 75% from baseline.
An unacceptable titration does not meet any of the above grades. Repeat titration should be considered.
The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies. Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment.
