study: self-titration as effective as lab titration

Perhaps this has been posted before, but it is new to me: http://www.ncbi.nlm.nih.gov/pubmed/12598214

Am J Respir Crit Care Med. 2003 Mar 1;167(5):716-22.
Can patients with obstructive sleep apnea titrate their own continuous positive airway pressure?

Fitzpatrick MF, Alloway CE, Wakeford TM, MacLean AW, Munt PW, Day AG.

Department of Medicine, Queen's University, Kingston, Ontario, Canada. mf19@post.queensu.ca

* Am J Respir Crit Care Med. 2003 Mar 1;167(5):674-5.

Abstract

Manual continuous positive airway pressure (CPAP) titration in a sleep laboratory is costly and limits access for diagnostic studies. Many factors affect CPAP compliance, but education and support, rather than in-laboratory CPAP titration, appear to be pivotal. Self-adjustment of CPAP at home will provide equal or superior efficacy in the treatment of obstructive sleep apnea (OSA) as compared with in-laboratory titration. A randomized, single-blind, two-period crossover trial of CPAP treatment at the in-laboratory-determined optimal pressure versus at-home self-adjustment of CPAP (starting pressure based on prediction equation). Eighteen CPAP-naive patients (16 males, 50 +/- 15 years old, apnea hypopnea index 40 +/- 20) with a new diagnosis of OSA were tested. Testing was performed before and after CPAP treatment in each of two 5-week study limbs. CPAP, compliance with CPAP treatment, the Sleep Apnea Quality of Life Index, the Functional Outcomes of Sleep Questionnaire score, the Epworth sleepiness scale score, sleep architecture, sleep apnea severity, and maintenance of wakefulness tests were performed. Both modes of CPAP treatment significantly improved objective and subjective measures of OSA, but they did not differ in efficacy. Home self-titration of CPAP is as effective as in-laboratory manual titration in the management of patients with OSA.

That thing was dated in 2003.
Think about how far the technology (hardware & software) has come since then.
"Rested Gal" has a number of links to similar articles and studies somewhere in her archived posts.


Den

Didn't the people conducting that study know that the home-titrating group could all die of strokes if they set their pressures too high?

YAWN. Another stupid medline abstract that means squat. When was the last time you were at the gym doing some cardio instead of surfing Medline for OSA abstracts?

Eric

Thank you, wolewyck. Yes, this has been mentioned before, but that' sthe kind of study that really should come up again every now and then. And browsing the "cited by" links will lead to us to updates.

Interesting point to ponder: the sample was small - but there has not yet been a study refuting these results.

Otter wrote:Didn't the people conducting that study know that the home-titrating group could all die of strokes if they set their pressures too high?

Seriously though: why would anyone set their pressure too high when they're instructed to set it for comfort and efficacy

...back to the diabetes analogy... you really can die of too much insulin - yet its amount is self titrated.

ozij wrote:Thank you, wolewyck. Yes, this has been mentioned before, but that' sthe kind of study that really should come up again every now and then. And browsing the "cited by" links will lead to us to updates.

I agree. I hadn't seen it before, and I was a little surprised that this research had been done, given how some in the industry react if you mention changing even the ramp settings on your own flow generator.

Wulfman wrote:"Rested Gal" has a number of links to similar articles and studies somewhere in her archived posts.


Den

Not just to a similar one, but to... that very one.

ALL LINKS by rested gal
viewtopic.php?t=17435

It's the eleventh link wayyyyy down below the dividing line that's underneath the link about tape. Like a scavenger hunt!

It was good to see you posting it, wolewyck....

because...as ozij wrote:that' sthe kind of study that really should come up again every now and then.

Interestingly, as far as I could tell when I first read that study, the people were given plain vanilla CPAP machines to do their self-titrating at home. There was apparently no treatment data for the people to look at, or I think that would have been mentioned.

So... if those CPAP naive people could successfully find for themselves a pressure that treated them effectively without the aid of software and without even getting to see AHI data results in the machine window.... then it sure sounds like a sufficiently effective titration of garden variety OSA ain't rocket science. They were given a PSG study beforehand to be sure the only people included in the study were people with plain old OSA, and not something more complicated.

That study took place before recognition of CompSAS hit the scene, I believe; but, evidently those people didn't have that complication. Just CPAP-treatable OSA, which is the most common type of sleep disordered breathing anyway. Very amenable to tweaking, imho.

Thanks for that link, I'm bumping it to the top. And here I thought I was doing something unheard of in the medical community (and possibly illegal)!

rested gal wrote:That study took place before recognition of CompSAS hit the scene, I believe; but, evidently those people didn't have that complication. Just CPAP-treatable OSA, which is the most common type of sleep disordered breathing anyway. Very amenable to tweaking, imho.

The abstract said that self titration was as efficacious as titration in a lab. If the people conducting the study weren't aware of complex sleep apnea, it's possible that there were one or two folks with CompSAS in each group, and that titration in ignorance of the syndrome works about as well at home as in the lab too.