Correlation of Therapeutic Pressure between Home Automatic Positive Airway Pressure and in Laboratory Polysomnography Manual Titration in Patients with Obstructive Sleep Apnea
Apiwat Pugongchai, MSc¹,², Kanyada Leelasittikul, MSc¹,², Narongkorn Saiphoklang, MD¹,²,³
Affiliation : ¹ Medical Diagnostics Unit, Thammasat University Hospital, Pathum Thani, Thailand; ² Sleep Center of Thammasat, Thammasat University Hospital, Pathum Thani, Thailand; ³ Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand
Background: Continuous positive airway pressure (CPAP) is an effective treatment for obstructive sleep apnea (OSA). Automatic positive airway pressure (APAP) used at home may serve as an alternative method to determine the optimal pressure for patients requiring CPAP treatment. However, data on the association between effective treatment pressure obtained from laboratory polysomnography (in-lab PSG) and home-based APAP are limited.
Objective: To determine the correlation between effective CPAP pressure derived from in-lab PSG and home APAP.
Materials and Methods: A prospective cohort study was conducted among adults (18 years and older) diagnosed with OSA who required CPAP therapy. Patients underwent in-lab PSG with manual CPAP titration to determine the effective treatment pressure, followed by home APAP use for two weeks to identify the 95th percentile pressure as the effective pressure.
Results: Fifty OSA patients (82% male) were included. The mean age was 48.9±14.6 years, and the mean body mass index was 28.7±6.1 kg/m². Polysomnographic data showed an effective treatment pressure of 10.4±2.9 cmH₂O, and an apnea-hypopnea index was 55.1±29.0 events per hour, with 76% classified as severe OSA. Home APAP data demonstrated an effective treatment pressure of 10.8±1.8 cmH₂O. There was a positive correlation between effective pressure obtained from home APAP and in-lab PSG (r=0.472, p=0.001). The predictive equation for in-lab effective pressure was predicted pressure (cmH₂O) = 2 + (0.78 × home APAP pressure). Bland-Altman analysis showed good agreement between the two methods, with a mean difference of –0.428 cmH₂O and 96% of data points within the limits of agreement.
Conclusion: Home APAP pressure was moderately positively correlated with in-lab PSG effective pressure. The accuracy of home APAP showed good agreement with in-lab manual CPAP titration, suggesting that home APAP may be a feasible alternative for determining effective therapeutic pressure in OSA treatment.
Received 10 November 2025 | Revised 28 March 2026 | Accepted 30 March 2026
DOI: 10.35755/jmedassocthai.2026.5.03915
Keywords : APAP; Automatic positive airway pressure; Continuous positive airway pressure; CPAP; Obstructive sleep apnea; OSA
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