Manual PAP titration in sleep lab: Focus on the aspect of BIPAP and ASV titration
Sleep disordered breathing encompasses a series of sleep-related breathing disorders such as obstructive sleep apnea (OSA), central sleep apnea (CSA) and hypoventilation syndrome. Positive airway pressure (PAP) therapy is an effective and common treatment for patients with sleep disordered breathing. Before the patient start PAP therapy, PAP titration should be executed to determine the optimal setting of PAP. PAP titration can be classified into CPAP, BIPAP and Adaptive-servo ventilation (ASV) titration. CPAP titration is the most common titration in sleep lab for patient with OSA. However, in the patients with congestive heart failure, obesity hypoventilation and neuromuscular diseases. CPAP may not afford to relieve the respiratory events among these patients. Advanced mode of PAP including BIPAP and ASV may be applied to these patients. Due to home-based automated CPAP titration may be applied to patient with OSA universally in the future. The proportion of patients with comorbidities will increase in laboratory titration in the future. In response to this situation, titration techniques of advanced PAP modes are essential for PSG technologists. In this talk, we will demonstrate the experience of BIPAP and ASV titration to increase the efficacy of advanced PAP titration.