0607 Grading the Adequacy of Positive Airway Pressure Titrations During Overnight in Lab Split Night Polysomnograms

Abstract Introduction The gold standard test for the diagnosis of Obstructive sleep apnea (OSA) is an overnight in lab polysomnogram (PSG). Split night PSG (first half of the study – diagnostic and the second half is positive airway pressure (PAP) titration to determine optimal PAP pressure is commonly used in clinical practice. American Academy of Sleep Medicine (AASM) has published guidelines grading the adequacy of these PAP titrations as Optimal, Good, Adequate and Unacceptable grades. There is a paucity of literature on the frequency of these AASM PAP titration grades noted in split night polysomnograms. Methods Split night PSG reports performed over six months were retrospectively reviewed. Patient’s Age, Sex, Body Mass Index, Neck circumference, Epworth Sleeping Scale Scores, Fatigue Severity Scale Scores, number of medical and psychiatric comorbidities, Apnea Hypopnea Index (AHI), Arousal Index and nadir oxygen saturation were collected and analyzed. PAP titrations were graded according to the AASM defined criteria as Optimal, Good, Adequate and Unacceptable titration grades by a board-certified sleep physician. Results A total of 284 studies were reviewed, 269 (94.7 %) were men. The age range was 25 to 87 years, median (IQR) 54(45 to 63) years. The mean (SD) Body Mass Index was 35.6(7.2) Kg/m2. The mean (SD) Epworth Sleepiness Scale Score was 13.1(5.2). The Apnea Hypopnea Index was median (IQR) 41.3(24.1 to 70.6) events per hour. The mean (SD) nadir oxygen saturation was 80(8) %. Titration met the AASM Optimal grade in 89 (31.3 %), Good Grade in 24 (8.4 %), Adequate grade in 113 (39.7%) and Unacceptable grade in 58 (20.4%) studies. Conclusion In this series of split-night polysomnograms of predominantly male US Veterans, the most common grade of PAP titration per AASM guidelines noted was Adequate grade, followed by Optimal grade, Unacceptable grade and Good grade respectively. In our series, only 40% of the split-night polysomnograms met the AASM criteria for a “successful titration” (Optimal or Good grade). This adds to the literature informing us on the frequency of AASM PAP titration grades and yield for a successful PAP titration of split-night polysomnograms in clinical practice. Support (if any) None