Comparisons of Continuous Positive Airway Pressures Determined by Conventional Manual Titration in a Sleep Center, During Sleep Endoscopy, and Auto-Titration at Home

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IMPORTANCE: Drug-induced sleep endoscopy (DISE) could be valuable to determine an appropriate therapeutic pressure for obstructive sleep apnea (OSA). OBJECTIVE: The continuous positive airway pressure (CPAP) determined by DISE was regarded as equal to the conventional titrating pressure. There is no study comparing the DISE-titrating pressure and the home-based automatic CPAP (APAP) titrating pressure. This study compared the DISE-titrating pressure, conventional titrating pressure, and home-based APAP titrating pressure. DESIGN: Retrospective comparative cohort study. SETTING: This study was conducted in a single medical center in Taiwan. PARTICIPANTS: A total of 59 participants with OSA who had 3 titrating pressures determined by DISE, conventional titration and home-based APAP titration were analyzed.Interventions or Exposures:Therapeutic CPAP pressure was determined by 3 methods: DISE, conventional titration, and home-based APAP titration. MAIN OUTCOME MEASURES: Home-based APAP titrating pressure was determined as 90% to 95% of APAP used at home for 2 weeks. The DISE-titrating pressure was determined manually based on direct visualization of upper airway patency during DISE examination. The conventional titrating pressure was determined manually under polysomnography (PSG) guidance in a sleep center. The correlation and difference between these 3 pressures were analyzed. RESULTS: O, respectively. Good reliability was observed in pairs between all 3 pressures. The DISE-titrating pressure and the conventional titrating pressure were lower than the home-based APAP titrating pressure. There was no difference between the DISE-titrating pressure and the conventional titrating pressure. CONCLUSIONS: DISE could help provide a therapeutic CPAP pressure similar to the conventional titrating pressure in sleep center and APAP titrating pressure at home. RELEVANCE: DISE could be a valuable alternative titrating method, especially in countries where PSG is expensive, time-consuming and difficult to access, and could facilitate earlier and more effective management of patients with OSA.

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