Table 5.

Clinical guidelines for manual CPAP titration

1. Adequate patient information, instruction, and adaptation of therapy

2. Titration of the CPAP pressure at which apneas, hypopneas, RERAs, and snoring no longer occur

3. Commence titration with 4 mbar (CPAP), or IPAP 8/EPAP 4 mbar (bilevel)

4. Max. CPAP: 15 mbar, max. IPAP: 20 mbar (bilevel), IPAP/EPAP difference: min. 4, max. 10 mbar

5. Where necessary, increase the pressure in 1‑mbar increments with a time interval of at least 5 min

6. Pressure is increased when at least two OSAs or three hypopneas or five RERAs or 3 min of loud snoring occur

7. Change to bilevel in cases of intolerance to CPAP or pressure >15 mbar

8. Therapeutic goal: RDI <5/h, min. oxygen saturation >90%

9. Optimal titration: RDI <5/h for at least 15 min, including REM sleep and no arousals

10. Good titration: RDI ≤10/h or 50% reduction of baseline in cases with a pretreatment RDI <15/h, including occurrence of REM sleep and reduction of waking reactions

11. Adequate titration: RDI >10/h, but a reduction by 75% of the baseline value; particularly in patients with severe OSAS or in patients with optimal titration in whom no REM sleep occurs

12. Unacceptable titration: fulfills none of the abovementioned criteria; and

13. A second titration night is necessary when the criteria for optimal/good titration are not fulfilled during the first night

CPAP continuous positive airway pressure, IPAP inspiratory positive airway pressure, EPAP expiratory positive airway pressure, RERA respiratory effort related arousal, RDI respiratory disturbance index, REM rapid eye movement, OSA obstructive sleep apnea, OSAS OSA syndrome