The prevalence of obstructive sleep apnea (OSA) is increasing requiring easier access to largescale screening and treatment of general population. Autotitrating Positive Airway Pressure (APAP) devices change effective pressure in a feedback circuit based on airflow, pressure changes, or airway resistance changes. This aids in pressure titration process throughout the sleep period. In patients with moderate to severe OSA without co-morbid conditions APAP and Continuous Airway Pressure (CPAP) are similar in affecting change in Apnea hypopnea index, Arousal index, and Sleep efficiency, Time in REM sleep, Quality of life, and adverse events. According to some studies, there has not been a significant difference in blood pressure changes between the APAP and CPAP groups. Current recommendations are to avoid APAP in patients with clinically significant co-morbid conditions including congestive heart failure, severe COPD, central sleep apnea, asthma and other obstructive pulmonary disorders or obesity hypoventilation syndrome and neuromuscular disorders. Further recommendation is to avoid using APAP for the diagnosis of OSA. Careful patient selection, monitoring of APAP data and proper mask fitting and leak control are essential to the success of APAP therapy. This article reviews the current scientific literature and emphasizes the need for more research before APAP can become the most efficacious mode of OSA treatment. Obstructive sleep apnea (OSA) prevalence is rising owing to many factors. Among these, obesity epidemic is considered a major confounder. Parallel with this increase in OSA, rapidly building public health and public safety burden drives the need for more widespread screening of the at-risk populations. Over the years, a gradual shift favoring “out of center testing” (OCST), popularly known as home sleep test (HST), portable monitoring (PM), and other names, has occurred. Autotitrating continuous positive airway pressure (APAP) was introduced in 1990, mainly for screening patients for nasal continuous positive airway pressure (CPAP) and for those patients whose health prevented visit to sleep laboratory for testing and CPAP titration. The combination of OCST and APAP use has literally eliminated the need for sleep laboratory from the management of OSA in many patients. The versatile technological design of APAP machine offers a wide range of pressures that responds to patient's variable breathing patterns and behaviors. The ability to track and monitor the results from these machines makes APAP a reasonable choice in properly selected patients.
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