Optimal level of continuous positive airway pressure: Auto-adjusting titration versus titration with a predictive equation

Objectives: The aims of the present study were twofold. We sought to compare two methods of titrating the level of continuous positive airway pressure (CPAP)-auto-adjusting titration and titration using a predictive equation-with full-night manual titration used as the benchmark. We also investigated the reliability of the two methods in patients with obstructive sleep apnea syndrome (OSAS). Methods: Twenty consecutive adult patients with OSAS who had successful, full-night manual and auto-adjusting CPAP titration participated in this study. The titration pressure level was calculated with a previously developed predictive equation based on body mass index and apnea-hypopnea index. Results: The mean titration pressure levels obtained with the manual, auto-adjusting, and predictive equation methods were 9.0 ± 3.6, 9.4 ± 3.0, and 8.1 ± 1.6 cm H2O, respectively. There was a significant difference in the concordance within the range of ±2 cm H2O (p = 0.019) between both the auto-adjusting titration and the titration using the predictive equation compared to the full-night manual titration. However, there was no significant difference in the concordance within the range of ±1 cm H2O (p > 0.999). Conclusions: When compared to full-night manual titration as the standard method, auto-adjusting titration appears to be more reliable than using a predictive equation for determining the optimal CPAP level in patients with OSAS.