Abstract
Purpose
It is costly and time-consuming to conduct the standard manual titration to identify an effective pressure before continuous positive airway pressure (CPAP) treatment for obstructive sleep apnea (OSA) patients. Automatic titration is cheaper and more easily available than manual titration. The purpose of this systematic review was to evaluate the effect of automatic titration in identifying a pressure and on the improvement of apnea/hyponea index (AHI) and somnolence, the change of sleep quality, and the acceptance and compliance of CPAP treatment, compared with the manual titration.
Methods
A systematic search was made of the PubMed, EMBASE, Cochrane Library, SCI, China Academic Journals Full-text Databases, Chinese Biomedical Literature Database, Chinese Scientific Journals Databases and Chinese Medical Association Journals. Randomized controlled trials comparing automatic titration and manual titration were reviewed. Studies were pooled to yield odds ratios (OR) or mean differences (MD) with 95% confidence intervals (CI).
Results
Ten trials involving 849 patients met the inclusion criteria. It is hard to identify a trend in the pressures determined by either automatic or manual titration. Automatic titration can improve the AHI (MD = 0.03/h, 95% CI = −4.48 to 4.53) and Epworth sleepiness scale (SMD = −0.02, 95% CI = −0.34 to 0.31,) as effectively as the manual titration. There is no difference between sleep architecture under automatic titration or manual titration. The acceptance of CPAP treatment (OR = 0.96, 95% CI = 0.60 to 1.55) and the compliance with treatment (MD = −0.04, 95% CI = −0.17 to 0.10) after automatic titration is not different from manual titration.
Conclusion
Automatic titration is as effective as standard manual titration in improving AHI, somnolence while maintaining sleep quality similar to the standard method. In addition, automatic titration has the same effect on the acceptance and compliance of CPAP treatment as manual titration. With the potential advantage of time and cost savings, automatic titration was recommended to be applied in identifying a proper pressure for CPAP treatment instead of manual titration in clinical practice.
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References
Marin JM, Carrizo SJ, Vicente E, Agusti AG (2005) Long-term cardiovascular outcomes in men with obstructive sleep apnoea–hypopnoea with or without treatment with continuous positive airway pressure: an observational study. Lancet 365:1046–1053
Gordon P, Sanders MH (2005) Sleep. 7: Positive airway pressure therapy for obstructive sleep apnoea/hypopnoea syndrome. Thorax 60:68–75
Kushida CA, Littner MR, Morgenthaler T, Alessi CA, Bailey D, Coleman J, Friedman L, Hirshkowitz M, Kapen S, Kramer M, Lee-Chiong T, Loube DL, Owens J, Pancer JP, Wise M (2005) Practice parameters for the indications for polysomnography and related procedures: an update for 2005. Sleep 28:499–521
Ayas NT, Patel SR, Malhotra A, Schulzer M, Malhotra M, Jung D, Fleetham J, White DP (2004) Auto-titrating versus standard continuous positive airway pressure for the treatment of obstructive sleep apnea: results of a meta-analysis. Sleep 27:249–253
Berry RB, Hill G, Thompson L, McLaurin V (2008) Portable monitoring and autotitration versus polysomnography for the diagnosis and treatment of sleep apnea. Sleep 31:1423–1431
Galetke W, Randerath WJ, Stieglitz S, Laumanns C, Anduleit N, Richter K, Schafer T (2009) Comparison of manual titration and automatic titration based on forced oscillation technique, flow and snoring in obstructive sleep apnea. Sleep Med 10:337–343. doi:10.1016/j.sleep.2008.03.007
Smith I, Lasserson TJ (2009) Pressure modification for improving usage of continuous positive airway pressure machines in adults with obstructive sleep apnoea. Cochrane Database Syst Rev, CD003531
Morgenthaler TI, Aurora N, Brown T, Zak R, Alessi C, Boehlecke B, Chesson AL, Friedman L, Kapur V, Maganti R, Owens J, Pancer J, Swick TJ (2008) Practice parameters for the use of autotitrating continuous positive airway pressure devices for titrating pressures and treating adult patients with obstructive sleep apnea syndrome: an update for 2007. An American Academy of Sleep Medicine report. Sleep 31:141–147
DerSimonian R, Laird N (1986) Meta-analysis in clinical trials. Control Clin Trials 7:177–188
Lloberes P, Rodriguez B, Roca A, Sagales MT, de la Calzada MD, Gimenez S, Romero O, Sampol G (2004) Comparison of conventional nighttime with automatic or manual daytime CPAP titration in unselected sleep apnea patients: study of the usefulness of daytime titration studies. Respir Med 98:619–625
Masa JF, Jimenez A, Duran J, Capote F, Monasterio C, Mayos M, Teran J, Hernandez L, Barbe F, Maimo A, Rubio M, Montserrat JM (2004) Alternative methods of titrating continuous positive airway pressure: a large multicenter study. Am J Respir Crit Care Med 170:1218–1224. doi:10.1164/rccm.200312-1787OC
Wan Y, Dong P, Zhu JC (2008) Relationship of CPAP pressure titration methods and CPAP compliance. Chin Arch Otolaryngol Head Neck Surg 15:107–109
McArdle N, Singh B, Murphy M, Gain KR, Maguire C, Mutch S, Hillman DR (2010) Continuous positive airway pressure titration for obstructive sleep apnoea: automatic versus manual titration. Thorax 65:606–611. doi:10.1136/thx.2009.116756
Fietze I, Glos M, Moebus I, Witt C, Penzel T, Baumann G (2007) Automatic pressure titration with APAP is as effective as manual titration with CPAP in patients with obstructive sleep apnea. Respiration 74:279–286
Stradling JR, Barbour C, Pitson DJ, Davies RJ (1997) Automatic nasal continuous positive airway pressure titration in the laboratory: patient outcomes. Thorax 52:72–75
Ficker JH, Clarenbach CF, Neukirchner C, Fuchs FS, Wiest GH, Schahin SP, Harsch IA, Hahn EG (2003) Auto-CPAP therapy based on the forced oscillation technique. Biomed Tech (Berl) 48:68–72
Shi M, Ni JH, Jiao XL, Bu JC (2004) Titration for continuous positive airway pressure therapy for OSAHS. Modern Pract Med 16:607–608
Garvey JF, McNicholas WT (2010) Continuous positive airway pressure therapy: new generations. Indian J Med Res 131:259–266
Johns MW (1993) Daytime sleepiness, snoring, and obstructive sleep apnea. The Epworth sleepiness scale. Chest 103:30–36
Meurice JC, Marc I, Series F (1996) Efficacy of auto-CPAP in the treatment of obstructive sleep apnea/hypopnea syndrome. Am J Respir Crit Care Med 153:794–798
Oliver Z, Hoffstein V (2000) Predicting effective continuous positive pressure. Chest 117:1061–1064. doi:10.1378/chest.117.4.1061
Loredo JS, Berry C, Nelesen RA, Dimsdale JE (2007) Prediction of continuous positive airway pressure in obstructive sleep apnea. Sleep Breath 11:45–51
Fitzpatrick MF, Alloway CED, Wakeford TM, Maclean AW, Munt PW, Day AG (2003) Can patients with obstructive sleep apnea titrate their own continuous positive airway pressure? Am J Respir Crit Care Med 167:716–722
Miu DS, Zhang XL (2009) The diagnostic and treating techniques of sleep-disordered breathing. People’s Military Medical Press, Beijing, p 5, in Chinese
Acknowledgments
This study could not have been conducted without the help of the technicians, physicians at the Center of Sleep-Disordered Breathing Medicine. Especially, we thank sleep technician Meinan Guo for teaching us lots of knowledge about the PSG and titration. We also acknowledge Jean Glover of Tianjin Medical University for helping in revising the paper.
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Gao, W., Jin, Y., Wang, Y. et al. Is automatic CPAP titration as effective as manual CPAP titration in OSAHS patients? A meta-analysis. Sleep Breath 16, 329–340 (2012). https://doi.org/10.1007/s11325-011-0495-z
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DOI: https://doi.org/10.1007/s11325-011-0495-z