Stradling J R, Hardinge M, Paxton J, Smith D M
Oxford Centre for Respiratory Medicine, Osler Chest Unit, Churchill Hospital, Oxford Radcliff Trust, University of Oxford, Oxford OX3 7LJ, UK.
Respir Med. 2004 Feb;98(2):152-4. doi: 10.1016/j.rmed.2003.09.009.
Patients with OSA on nasal continuous positive airway pressure (CPAP) have considerable night-to-night variation in their pressure requirements, suggesting that a one-night titration might not be very precise. This study investigates the likely error incurred using a one-night titration, and explores whether an algorithm-based approach to determine the pressure is as accurate.
Thirty patients with OSA used an autotitrating CPAP device for 28 nights and the average was regarded as the 'reference' pressure for that patient. Using estimates of precision and bias, this 'reference' pressure was compared with (1) an algorithm-derived pressure (based on neck circumference and OSA severity), (2) a one-night titration (using four alternative nights), and (3) a fixed pressure of 10 cmH2O.
The mean 'reference' pressure for the group was 9.83 (SD 2.12) cmH2O. There was little bias from any of the alternatives. However, the precision varied between 1.65 and 2.45 cmH2O for the four one-night titrations, was 2.00 for the algorithm, and was 2.12 using a fixed pressure of 10 cmH2O.
Considerable night-to-night variation means that a one-night titration is not very precise and is subject to random variation. A one-night titration has a similar inaccuracy to that resulting from using an algorithm, based on OSA severity and neck circumference. Setting all patients with OSA at 10 cmH2O is little worse.
使用鼻持续气道正压通气（CPAP）治疗阻塞性睡眠呼吸暂停（OSA）的患者，其压力需求在夜间存在相当大的变化，这表明一晚的滴定可能不太精确。本研究调查了一晚滴定可能产生的误差，并探讨基于算法确定压力是否同样准确。
30例OSA患者使用自动滴定CPAP设备28晚，其平均值被视为该患者的“参考”压力。利用精度和偏差估计，将该“参考”压力与以下各项进行比较：（1）算法得出的压力（基于颈围和OSA严重程度），（2）一晚滴定（使用四个不同夜晚），以及（3）10 cmH₂O的固定压力。
该组患者的平均“参考”压力为9.83（标准差2.12）cmH₂O。任何一种方法的偏差都很小。然而，四次一晚滴定的精度在1.65至2.45 cmH₂O之间，算法的精度为2.00，使用10 cmH₂O固定压力时的精度为2.12。
夜间的显著变化意味着一晚滴定不太精确且存在随机变化。一晚滴定的不准确性与基于OSA严重程度和颈围的算法所导致的不准确性相似。将所有OSA患者的压力设定为10 cmH₂O，情况也不会更糟多少。
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