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Efficacy of daytime continuous positive airway pressure titration in severe obstructive sleep apnoea

Respiratory Division, McGill University Health Centre, Royal Victoria Hospital, Montréal, Quebéc, Canada

CORRESPONDENCE: R.J. Kimoff, Respiratory Division, Room L4.08, MUHC-Royal Victoria Hospital, 687 Pine Ave West, Montreal, Quebec, Canada, H3A 1A1. Fax: 514 8431695

Keywords: Polysomnography, positive-pressure respiration, sleep apnoea syndromes

Received: July 20, 2000
Accepted May 1, 2001

This study was supported by Vitalaire Montreal and ResMed Inc.

The aim of this study was to evaluate manual nasal continuous positive airway pressure (nCPAP) titration during daytime polysomnography compared with conventional overnight titration for patients with severe obstructive sleep apnoea.

Thirty-two patients who underwent daytime titration were retrospectively matched (for age, sex, body mass index and apnoea/hypopnoea index (AHI)) to a group titrated overnight during the same period. Successful titration was defined as the identification of the nCPAP level (effective nCPAP (P_eff)) required to eliminate respiratory events during all sleep stages. After 3 months of therapy on nCPAP at P_eff, nCPAP utilization history was obtained and a group of patients underwent a repeat polysomnogram (PSG) and completed a follow-up Epworth Sleepiness Scale (ESS) score.

Initial titration was successful in 91% of daytime patients and 91% of overnight patients. The success of daytime titration was not related to diagnostic AHI or ESS score. Subjective nCPAP utilization was statistically similar in both groups. On the follow-up PSG, there were no significant differences between daytime (n=11) and overnight (n=11) patients in measures of sleep quality or respiratory disturbance. Both groups demonstrated similar and significant improvements in ESS score.

These findings suggest that the effective nasal continuous positive airway pressure can be accurately established during daytime titration in a substantial proportion of severe, symptomatic obstructive sleep apnoea patients.

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