According to the AASM, what is required for optimal PAP titration?

The optimal PAP titration according to the American Academy of Sleep Medicine (AASM) requires an Apnea-Hypopnea Index (AHI) of less than 5, along with the stipulation that there should be at least 15 minutes of supine stage R (REM) sleep without frequent spontaneous arousals. This requirement is critical as it ensures that the patient is not only achieving a low AHI but is also stable during REM sleep, which can be a challenging phase for those with obstructive sleep apnea. REM sleep often presents unique challenges for ventilation due to the natural atonia of the muscles involved in respiration, making a stable and adequate titration of positive airway pressure during this time essential for optimal therapy outcomes.

This combination helps to ensure that the titration is effective across different sleep stages and minimizes the risk of obstructive events, thereby improving overall patient care and treatment efficacy. The focus on REM sleep is particularly important because some patients may experience more severe symptoms during this stage, necessitating a careful approach to titration.