To set the correct levels of positive airway pressure therapy to correct the abnormal breathing during sleep.
To establish the diagnosis of obstructive sleep apnea or other forms of sleep breathing disorders such as central sleep apnea or sleep hypoventilation and if significant sleep apnea is detected to set the correct levels of positive airway pressure therapy to correct the abnormal breathing during sleep. If a split night sleep study was ordered but it could not be performed and the sleep doctors think you need to return for a second study (also called a CPAP or positive airway pressure titration study) then the sleep center staff can schedule you for the second night in the laboratory. A CPAP or positive airway pressure titration study is performed on someone who has already been diagnosed with sleep apnea or a sleep related breathing disorder by an overnight sleep study or polysomnogram.
The mask that is placed on your nose (or nose and mouth) can detect air flow and whether there is any evidence of upper airway narrowing and collapse.
The overnight titration study should be performed in a facility accredited by the American Academy of Sleep Medicine (AASM) according to the guidelines set forth by the AASM PAP Titration Task Force in February 2008.
The PAP Titration Task Force provides guidelines on the minimum pressure required and how to increase pressure during titration. Since a successful titration can only occur if the child is asleep, an experienced pediatric sleep technologist trained in working with children of various ages and illnesses can increase the likelihood of success. Techniques for increasing and decreasing pressures should be used during CPAP and BPAP titrations to facilitate sleep.
The two most common forms of positive airway pressure therapy are continuous positive airway pressure (CPAP) or bi-level positive airway pressure (bi-level PAP). Alternatively, the original referring physician who ordered the split night sleep study can order a CPAP or positive airway pressure titration study after reviewing the results of the initial overnight sleep study. Therefore, a prior overnight sleep study or polysomnogram is necessary for the sleep center to perform a CPAP titration study. However, Expedited CPAP Care Program needs to be ordered by your physician when the CPAP titration study is scheduled.

A sleep medicine expert shares important information on implementation, titration, and maximizing outcomes.
Patients should have an initial evaluation by their physician and receive PAP therapy education, hands-on demonstration, and careful mask fitting, allowing adequate time for acclimation to the device prior to overnight titration.4 It is essential to gain the trust of the patient and caregiver and not to treat these patients as little adults. The titration process consists of collecting data recording the effects and tolerance of various pressures on the patient. For patients less than 12 years of age, the recommended starting pressure is a CPAP of 4 cm H2O and maximum pressure of 15 cm H2O. The starting EPAP pressure, or beginning CPAP pressure at which the obstructive respiratory events are eliminated, is recommended at 4 cm H2O. The titration is considered optimal when the respiratory disturbance index (RDI) is less than 5 per hour for a minimum of 15 minutes with acceptable mask leak.
Sleep physicians will determine therapeutic pressures based on the data collected by the sleep technologist. The PAP Titration Task Force mentions increasing PAP or IPAP pressures by 2 to 5 cm H2O greater than the pressure at which respiratory events are eliminated. CPAP and bi-level PAP are devices that generate flow and the pressure generated maintains upper airway patency to relieve apneas, shallow breathing, and snoring. The goal is to find the right level of air pressure that will prevent the collapse of your upper airway and to correct the oxygen levels.
In contrast, down titration may be considered following a minimum of 30 minutes of recording time without obstructive events.
Clinical guidelines for the manual titration of positive airway pressure in patients with obstructive sleep apnea. Adherence to and effectiveness of positive airway pressure therapy in children with obstructive sleep apnea.

The mask allows the air to gently blow into the back of your throat to maintain you upper airway open so that you can breathe normally. For patients 12 years of age and older, the recommended starting pressure is the same as above but the maximum pressure is 20 cm H2O. A reduction of 1 cm H2O with a minimum of 10 minutes until obstructive events reappear is recommended for PAP and IPAP titrations.
The results will be given to a board-certified sleep specialist who will review the study to determine the appropriate pressure levels required to treat your sleep apnea. A good titration is an RDI less than 10 per hour (or the RDI was reduced by half if the baseline RDI was less than 15) for a minimum of 15 minutes.
During the study CPAP (or other forms of positive airway pressure therapy) is titrated so that your breathing and oxygen levels become normal. For split-night studies where PAP therapy is added during the middle of the study, PAP pressures can be increased by a minimum of 2 cm H2O with at least 5 minutes at each pressure due to the limited time to obtain optimal results. Adequate titration is defined when the RDI is not less than 10 per hour, but the number of respiratory events is reduced by 75% from baseline, meeting the same criteria as optimal and good with no supine REM. A titration is considered unacceptable if the final results do not meet any of the mentioned criteria with less than 3 hours of titration time. Unacceptable titrations tend to occur more often with children and may require a repeat study.4 These guidelines are from the AASM task force scale, but some physicians may use different parameters.

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