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Sleep Disorders |

Algorithm Based CPAP Titration Formulas: A Comparison and Review

Ryu Tofts*, MBChB; Marlow Hernandez, DO; Amitesh Agarwal, MD; Rodrigo Velasco-Hernandez, MD; Crystal Dixon, MD; Natalie Sabzghabaei, MD; Khalid Baosman, MD; Aashish Khullar, MD; Navaneetha Sheshadri, MD; Natasha Bhimani, MD; Tanmay Sahai, MD; Mustafa Wardak, MD; Hardik Patel, MD; Hamayon Babary, MD; Oliveira Eduardo, MD; Franck Rahaghi, MD; Ferrer Gustavo, MD; Ramirez Jose, MD; Laurence Smolley, MD; Ndubuisi Okafor, MD; Hadeh Anas, MD
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Cleveland Clinic Florida, Weston, FL


Chest. 2012;142(4_MeetingAbstracts):1054A. doi:10.1378/chest.1372265
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Abstract

SESSION TYPE: Sleep II

PRESENTED ON: Monday, October 22, 2012 at 04:00 PM - 05:30 PM

PURPOSE: Several algorithm-based positive airway pressure (PAP) titration formulas for obstructive sleep apnea (OSA) exist; Hoffstein, Series, Loredo and our own Cleveland Clinic Predictor (CCP). However, variations in pressures exist between the same phenotype and nightly in the same individual. Some suggest universally starting at 10cm H20 is not unreasonable. We compared four predictive formulas and an arbitrarily fixed value of 10cm H2O against a manually titrated PAP pressure (Ppeff) for accuracy.

METHODS: We conducted a retrospective review of all patients from 2004 to 2010 with a diagnosis of OSA and a titration PAP study. Standard PAP titration was performed per American Academy of Sleep medicine guidelines and was successful if apneas were abolished. We gathered patient information: age, gender, race, existent pulmonary conditions, height (cm), weight (kg), neck circumference (cm), body mass index (BMI), Mallampati score, Epworth score (EPP), Respiratory distress index (RDI), Apnea-Hyponea index crude (AHI-crude), AHI-supine, AHI-REM, nadir and mean oxygen saturation. Accuracy was defined as predicted pressures (Ppred) within +/-2 of the Ppeff. Ppred generated by four formulas (Hoffstein, Series, Loredo and CCP) and arbitrary 10cm H20 were compared against the Ppeff.

RESULTS: Our total sample size was n=1877 patients, male 1408 (75%), mean age 53.1, BMI 35.8, crude AHI 41.3, ESS 11.3, and RDI 19.6. The Ppeff range was 5 to 20, mean was 10.357 (95% CI 10.25 to 10.46), median was 10.00 (95% CI 10 to 10.) Sample sizes for each formula varied; Hoffstein n=1227, Series n=1227, Loredo n= 1576, and CCP n=1877. Accuracy was found to be: Hoffstein 49.2% (range 16 (lowest -7.1 to highest 9.6)), Series 72.6% (17.6 (-10.1 to 7.5)), Loredo 66.6% (16 (-4.9 to 11.1)), CCP 74.3% (16.5 (-7.2 to 9.3)) and arbitrary 10cm H20 75.9% (15 (-5 to 10)).

CONCLUSIONS: In a large sample size predictive formulas were not as accurate as an arbitrarily fixed value of 10cm H20.

CLINICAL IMPLICATIONS: There are no short cuts to PAP titration, the most efficient method is with a manual titration.

DISCLOSURE: The following authors have nothing to disclose: Ryu Tofts, Marlow Hernandez, Amitesh Agarwal, Rodrigo Velasco-Hernandez, Crystal Dixon, Natalie Sabzghabaei, Khalid Baosman, Aashish Khullar, Navaneetha Sheshadri, Natasha Bhimani, Tanmay Sahai, Mustafa Wardak, Hardik Patel, Hamayon Babary, Oliveira Eduardo, Franck Rahaghi, Ferrer Gustavo, Ramirez Jose, Laurence Smolley, Ndubuisi Okafor, Hadeh Anas

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Cleveland Clinic Florida, Weston, FL

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