This is the current release of the guideline.

This guideline updates a previous version: Standards of Practice Committee. Practice parameters for the use of auto-titrating continuous positive airway pressure devices for titrating pressures and treating adult patients with obstructive sleep apnea. Sleep 2002;25(2):143-7.

The evidence levels (I-IV) and the levels of recommendations (standard, guideline, option) are defined at the end of the "Major Recommendations" field.

Auto-titrating continuous positive airway pressure (APAP) is not recommended to diagnosis obstructive sleep apnea (OSA). (Standard)

Patients with congestive heart failure, significant lung disease such as chronic obstructive pulmonary disease, patients expected to have nocturnal arterial oxyhemoglobin desaturation due to conditions other than OSA (e.g., obesity hypoventilation syndrome), patients who do not snore (either naturally or as a result of palate surgery), and patients who have central sleep apnea syndromes are not currently candidates for APAP titration or treatment. (Standard)

APAP devices are not currently recommended for split-night titration. (Standard)

Certain APAP devices may be used during attended titration with polysomnography to identify a single pressure for use with standard continuous positive airway pressure (CPAP) for treatment of moderate to severe OSA (Guideline)

Certain APAP devices may be initiated and used in the self-adjusting mode for unattended treatment of patients with moderate to severe OSA without significant comorbidities (congestive heart failure [CHF], chronic obstructive pulmonary disease [COPD], central sleep apnea syndromes, or hypoventilation syndromes). (Option)

Certain APAP devices may be used in an unattended way to determine a fixed CPAP treatment pressure for patients with moderate to severe OSA without significant comorbidities (CHF, COPD, central sleep apnea syndromes, or hypoventilation syndromes). (Option)

Patients being treated with fixed CPAP on the basis of APAP titration or being treated with APAP must have close clinical follow-up to determine treatment effectiveness and safety. This is especially important during the first few weeks of positive airway pressure (PAP) use. (Standard)

A reevaluation and, if necessary, a standard attended CPAP titration should be performed if symptoms do not resolve or if the APAP treatment otherwise appears to lack efficacy. (Standard)

Definitions:

Evidence Levels

1. Randomized, well-designed trials with low alpha and beta error
2. Randomized trials with high alpha and beta error
3. Nonrandomized concurrently controlled studies
4. Nonrandomized historically controlled studies
5. Case series

Levels of Recommendations

Standard - This is a generally accepted patient-care strategy, which reflects a high degree of clinical certainty. The term standard generally implies the use of Level I Evidence, which directly addresses the clinical issue, or overwhelming Level II Evidence.

Guideline - This is a patient-care strategy, which reflects a moderate degree of clinical certainty. The term guideline implies the use of Level II Evidence or a consensus of Level III Evidence.

Option - This is a patient-care strategy, which reflects uncertain clinical use. The term option implies either inconclusive or conflicting evidence or conflicting expert opinion.

None provided

The type of supporting evidence is identified and graded for each recommendation (see the "Major Recommendations" field).

Not applicable: The guideline was not adapted from another source.

2002 March 15 (revised 2008 Jan)

American Academy of Sleep Medicine - Professional Association

American Academy of Sleep Medicine

Standards of Practice Committee

Standards of Practice Committee: Timothy I. Morgenthaler, MD; R. Nisha Aurora, MD; Terry Brown, DO; Rochelle Zak, MD; Cathy Alessi, MD; Brian Boehlecke, MD; Andrew L. Chesson Jr, MD; Leah Friedman, MA, PhD; Vishesh Kapur, MD, MPH; Rama Maganti, MD; Judith Owens, MD; Jeffrey Pancer, DDS; Todd J. Swick, MD

All members of the American Academy of Sleep Medicine´s Standards of Practice Committee and Board of Directors completed detailed conflict-of-interest statements and were found to have no conflicts of interest with regard to this subject.

This is the current release of the guideline.

This guideline updates a previous version: Standards of Practice Committee. Practice parameters for the use of auto-titrating continuous positive airway pressure devices for titrating pressures and treating adult patients with obstructive sleep apnea. Sleep 2002;25(2):143-7.

None available

None available

This summary was completed by ECRI on July 19, 2002. The information was verified by the guideline developer on September 13, 2002. This NGC summary was updated by ECRI Institute on May 13, 2008.

This NGC summary is based on the original guideline, which is subject to the guideline developer's copyright restrictions. Please contact the American Academy of Sleep Medicine (AASM) for information regarding reproduction of AASM guidelines.