During PAP titration, achieving an RDI less than 5 for at least 15 minutes with supine REM sleep observed at the pressure is an example of what?

During PAP titration, achieving an RDI less than 5 for at least 15 minutes with supine REM sleep observed at the pressure is an example of what?

• A. RDI <5 for at least 15 minutes with supine REM sleep observed at the selected pressure
• B. RDI <5 for 5 minutes with any sleep stage at the selected pressure
• C. RDI <10 with supine sleep only
• D. RDI not reduced to <5 but reduced by 50% in severe patients

Answer: (A)

In PAP titration, the pressure is considered adequate when the residual respiratory disturbance is suppressed to a mild level under the most challenging sleep conditions. Observing an RDI below 5 events per hour for at least 15 consecutive minutes specifically while the patient is in supine REM sleep at the tested pressure shows that the device effectively controls apneas, hypopneas, and RERAs even during REM when airway collapse tends to worsen, and in the position where it is most likely to occur. This combination—RDI <5, a 15-minute duration, and REM sleep in the supine position—provides strong evidence the chosen pressure will maintain good control across typical sleep. Shorter durations, or requiring control during any sleep stage or at a higher RDI threshold, would not equally demonstrate reliable titration. Likewise, merely reducing events by a percentage without achieving the <5 threshold isn’t considered sufficient to declare adequate control during titration.

In PAP titration, the pressure is considered adequate when the residual respiratory disturbance is suppressed to a mild level under the most challenging sleep conditions. Observing an RDI below 5 events per hour for at least 15 consecutive minutes specifically while the patient is in supine REM sleep at the tested pressure shows that the device effectively controls apneas, hypopneas, and RERAs even during REM when airway collapse tends to worsen, and in the position where it is most likely to occur. This combination—RDI <5, a 15-minute duration, and REM sleep in the supine position—provides strong evidence the chosen pressure will maintain good control across typical sleep. Shorter durations, or requiring control during any sleep stage or at a higher RDI threshold, would not equally demonstrate reliable titration. Likewise, merely reducing events by a percentage without achieving the <5 threshold isn’t considered sufficient to declare adequate control during titration.