APAP and alternative titration methods

Positive airway pressure therapy (PAP) is a commonly prescribed treatment for obstructive sleep apnea (OSA). Traditionally, a sleep technician determined the optimal pressure for treatment of sleep-disordered breathing (SDB) through manual titration of the device during polysomnography. However, alternative methods for determination of optimal PAP, such as autotitrating PAP (APAP), have seen tremendous growth over the past decade. The purpose of this article is to improve understanding of the currently available alternative methods for titration of PAP in patients with SDB with special emphasis on OSA. Recent prospective randomized studies of alternative methods of titration suggest that pressure determinations made by these devices are comparable to traditional manual titrations made in the sleep laboratory. Obstacles to the adoption of these alternative modes of titration into daily practice may be attributable to issues surrounding appropriate patient selection, differences between devices, reimbursement policies of third-party payors, consensus among sleep experts, and individual physicians' practice patterns and volumes. Although newer generations and types of APAP devices are entering the sleep field constantly, providers' knowledge and time availability remain limiting factors. Tremendous growth is occurring in technology and scientific evidence supporting alternative modes of PAP titration for SDB, but barriers to implementation remain.