This chapter reviewed the rationale for the design of BPAP to treat patients with SDB primarily due to OSA and additional clinical recommendations from evidence review and practice parameter paper were published in 2006 (23,41). Even though there have been no comparative studies to determine the optimal titration protocol, a few titration techniques were discussed above. There was no evidence found that BPAP improves efficacy or adherence to therapy in OSA patients who are first-time PAP users but studies did at least support equivalency of CPAP and BPAP. There was also no evidence available to support the practice of BPAP use at an arbitrary higher level of CPAP pressure during a routine titration of OSA patients. There may be some role for BPAP treatment in patients who have struggled with CPAP but there is limited data. Special considerations are also needed for patients with mixed apnea or CompSA who respond poorly to CPAP and it seems most appropriate to

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