Predictors of retitration in the sleep laboratory: Experience of a single center

Background: Obstructive sleep apnea syndrome (OSAS) is a serious public health problem that causes a significant economic burden worldwide. Apart from several treatment approaches, positive airway pressure (PAP) therapy remains the gold standard. Performing an optimal manual titration study to explore the beneficial and comfortable pressure for patients is essential, but the process is troublous sometimes, requiring multiple attempts. The objective of this study was to present our single-center experience regarding PAP titration studies in OSAS and identify the clinical and laboratory parameters that might predict repeat titration. Materials and Methods: Medical charts of 248 patients with OSAS who were eligible for PAP therapy were retrospectively reviewed. Age, sex, body mass index, modified Mallampati scores, presence of positive Muller maneuvers, and polysomnographic parameters yielded from diagnostic studies were recorded and compared between patients with single versus repeat titrations. Results: The mean age, the proportion of males, and the rate of patients with positive Muller maneuvers were significantly increased in the retitration group (P = 0.015, P = 0.022, and P = 0.001, respectively). Multivariate regression analysis revealed that age and positive Muller maneuvers were independent associates of repeat titration (P = 0.036 and P = 0.005, respectively). Conclusion: Our results suggest that both aging and the presence of a positive Muller maneuver may predict a troublous titration study, raising the need for recurrent attempts. The final common pathway could contribute to a vulnerable and more collapsible airway during sleep. Recognizing the potential need for retitration at the beginning is favorable regarding adjustment of the laboratory conditions and increases the patients' adherence during the management course. The results also confirm the capability of manual titration in terms of exploring proper PAP pressures in the majority of patients with OSAS.