The Split Night Study

It has been suggested that CPAP can be successfully initiated on the same night the diagnosis is established (42,43). However, in these studies patient selection was not randomized and split-night studies tended to be performed in patients with more severe disease, who had been waiting a shorter time for their CPAP titration. Others have identified a subset of patients for whom a split-night study provided insufficient time for CPAP titration to achieve a satisfactory prescription (44). Patients with milder degrees of sleep-disordered breathing (SDB) [apnea-hypopnea index (AHI) less than 20 events per hour] in whom the titration is initiated later in the night (because prolonged monitoring was required to establish a diagnosis) were more likely to have unsuccessful split-night titrations. CPAP can also potentially be titrated during the day (45). With these approaches, both daytime and nocturnal CPAP titration studies yielded sufficient amounts of REM and NREM sleep to help determine CPAP settings. The diurnal and nocturnal CPAP titrations resulted in comparable therapeutic pressures, resolution of SDB, and one-week adherence. Split-night or day studies may appear attractive from a cursory economic point of view. The full economic impact of such techniques must, necessarily, include the ultimate costs of improper or inadequate titration (both in retitration, cost of untreated sleep-disordered breathing, and attendant preventable comorbidity). Data in larger numbers of unselected patients are required before these ultimate economic consequences are known and this approach is routinely accepted. It is possible but speculative at this stage, depending on outcome studies, whether a combination of split-night titration and subsequent home auto-titration may provide an adequate and cost-effective strategy.

Sleep Apnea

Sleep Apnea

Have You Been Told Over And Over Again That You Snore A Lot, But You Choose To Ignore It? Have you been experiencing lack of sleep at night and find yourself waking up in the wee hours of the morning to find yourself gasping for air?

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