Daytime CPAP Titration *

Objective: Continuous positive airway pressure (CPAP) is the treatment of choice for patients diagnosed with severe obstructive sleep apnea (OSA). The implementation of CPAP therapy has traditionally been based on full-night titration studies or split-night protocols. This study compared a group of patients who received a regular nocturnal CPAP titration with patients who received a daytime CPAP titration. The objective of the study was to determine if daytime CPAP titration is a viable alternative for the implementation of CPAP treatment in patients with severe OSA. Study design: Fourteen patients (13 men and one woman) received a daytime CPAP titration (day group). The day group was matched to 18 patients (17 men and one woman) who were titrated under a full-night regular nocturnal study (night group). Eligible patients were those with severe OSA (respiratory event index > 40). The groups were matched by age, sex, and body mass index. Results: Daytime and nocturnal CPAP titration studies yielded sufficient amounts of rapid eye movement (REM) and non-REM sleep to help determine CPAP settings. Importantly, the diurnal and nocturnal CPAP titrations resulted in comparable therapeutic pressures as well as compa¬ rable resolution of sleep-disordered breathing. After 1 week of treatment, the groups exhibited similar CPAP use and comparable improvements in subjective sleepiness as indicated by their increase in sleep/wake activity inventory scores. Conclusions: Daytime CPAP titration studies may be a viable alternative for the efficient and expedient implementation of CPAP therapy among some patients with severe OSA. (CHEST 1998; 114:1056-1060)