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FIGURE 4 This is a single night profile of pressure, leak, and residual apnea-hypopnea index (AHI) of an ideal titration. The leak and residual AHI are low. The 95th percentile pressure was 9.4 cm H2O. The patient was treated with a prescription pressure of 10 cm H2O. Source: From Ref. 42.

FIGURE 5 This is a single night profile of pressure, leak and residual apnea-hypopnea index (AHI) of a fair titration. The leak is higher than ideal (> 0.4 L/s) at times. However, the residual AHI remained low. The 95th percentile pressure was 7.8 cm H2O. The prescription pressure was chosen to be 8 cm H2O.

FIGURE 5 This is a single night profile of pressure, leak and residual apnea-hypopnea index (AHI) of a fair titration. The leak is higher than ideal (> 0.4 L/s) at times. However, the residual AHI remained low. The 95th percentile pressure was 7.8 cm H2O. The prescription pressure was chosen to be 8 cm H2O.

high leak but the residual AHI remains low. In Figure 6 an unacceptable auto-titration is shown. Very high leak is obvious and the machine pressure climbed to the upper pressure limit and stayed there for most of the night. In Table 2 examples of results for two patients undergoing auto-titration are illustrated. In patient one the statistics from five days of monitoring showed a low-residual AHI. In patient two, the results of a single night showed a very high residual apnea index. The latter patient underwent an attended titration and was found to have a significant number of central apneas.

A number of portable monitoring units can interface with selected APAP devices. For example, airflow, respiratory effort, oxygen saturation, body position, and delivered pressure can be recorded for clinician analysis (23). This is especially helpful if one night of APAP titration is utilized. For example, absence of supine sleep could result in a lower than typically needed prescription pressure. This is also a reason that it is often helpful to have the patient use the APAP device for several nights. Average statistics over a week may more accurately represent a typical night's pressure requirements. Information from pulse oximetry during the APAP titration can identify the need for the addition of supplemental oxygen.

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