Choosing Wisely:

Don’t perform positive airway pressure retitration studies in asymptomatic, adherent patients with sleep apnea and stable weight.

Rationale and Comments: Retitration of positive airway pressure is not indicated for adult obstructive sleep apnea patients with stable weight whose symptoms are well-controlled by their current positive airway pressure treatment. Follow-up polysomnography or retitration is indicated for adult patients who are again symptomatic despite the continued, proper use of positive airway pressure, especially if they have gained substantial weight (e.g., 10% of original weight) since the last titration study. A new diagnostic polysomnography or retitration may be indicated for patients who have lost substantial weight, to determine whether positive airway pressure treatment is still necessary.
Sponsoring Organizations:
  • American Academy of Sleep Medicine
  • Sources:
  • American Academy of Sleep guidelines
  • Disciplines:
  • Pulmonary medicine
  • References: • Kushida CA, Littner MR, Morgenthaler T, Alessi CA, Bailey D, Coleman J Jr, Friedman L, Hirshkowitz M, Kapen S, Kramer M, Lee-Chiong T, Loube DL, Owens J, Pancer JP, Wise M. Practice parameters for the indications for polysomnography and related procedures: An update for 2005. Sleep. 2005;28(4):499-521.
    • Epstein LJ, Kristo D, Strollo PJ Jr, Friedman N, Malhotra A, Patil SP, Ramar K, Rogers R, Schwab RJ, Weaver EM, Weinstein MD; Adult Obstructive Sleep Apnea Task Force of the American Academy of Sleep Medicine. Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med. 2009;5(3):263-76.

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