Sleep Centers titrations inconsistent

This is an interesting article to read:

http://www.aasmnet.org/resources/clinic ... 040210.pdf

This is a 2008 article.

One thing stood out on page 159, Section 3.0 Background

Quote:

"The manual titration of positive airway pressure has been conducted for over a quarter of a century, yet not standardized protocols exist for this procedure. a survey of accredited sleep centers reviewed titration procedures from 51 accredited centers and found that the procedures described for PAP titration varied widely among the centers; 22% of these centers did not have a written protocol. "

The article describes where these sleep centers get their protocols.

Resuming the quote:

"When a standardized protocol is implemented, the optimal pressure for CPAP can be reproducible; one study revealed a Spearman correlation coefficient of 0.89 for the optimal pressure selected for 2 consecutive CPAP titration nights in 50 patients with OSA."

It is fairly shocking that 22% of these centers don't have a written protocol. The second quote suggests that when there isn't a standard protocol the results may vary much more. How seriously should we take the pressure settings prescribed for us?

The article is correct, methods based on developed standards do work better. That is why any industrial operation or any technical operation uses industry or professional standards.

This study is good though, hopefully it changes practice. Next time a doctor wants you to do a sleep study, ask the doctor if the center uses a standard protocol and more importantly the name and reference number of the protocol document.

Here is a link to an aasmnet sleep center titration protocol document.
Perhaps some progress has been made in the last six years.

http://www.aasmnet.org/Resources/Clinic ... 040210.pdf