What is the standard BiPAP (Bilevel Positive Airway Pressure) pressure support (PS) setting for Obstructive Sleep Apnea (OSA)?

Standard BiPAP Pressure Support Settings for Obstructive Sleep Apnea

For patients with OSA, the standard BiPAP settings include a minimum starting IPAP of 8 cm H2O and EPAP of 4 cm H2O, with a recommended IPAP-EPAP differential of 4-10 cm H2O. 1, 2

Initial BiPAP Settings

• The minimum starting IPAP and EPAP should be 8 cm H2O and 4 cm H2O, respectively, for both pediatric and adult patients 1
• The maximum recommended IPAP is 20 cm H2O for patients <12 years and 30 cm H2O for patients ≥12 years 1, 2
• The minimum IPAP-EPAP differential (pressure support) should be 4 cm H2O 1, 2
• The maximum IPAP-EPAP differential should not exceed 10 cm H2O 1, 2

BiPAP Titration Process

• IPAP and/or EPAP should be increased by at least 1 cm H2O with intervals no shorter than 5 minutes 1, 2
• Titration should continue until respiratory events are eliminated or maximum recommended pressure is reached 1, 2
• The goal is to achieve at least 30 minutes without breathing events 1, 2

When to Increase Pressures

• Increase both IPAP and EPAP if at least 1 obstructive apnea is observed for patients <12 years or if at least 2 obstructive apneas are observed for patients ≥12 years 1
• Increase IPAP if at least 1 hypopnea is observed for patients <12 years or if at least 3 hypopneas are observed for patients ≥12 years 1
• Increase IPAP if at least 3 RERAs (respiratory effort-related arousals) are observed for patients <12 years or if at least 5 RERAs are observed for patients ≥12 years 1
• Consider increasing IPAP if at least 1 minute of loud or unambiguous snoring is observed for patients <12 years or if at least 3 minutes of snoring are observed for patients ≥12 years 1

When to Consider BiPAP Instead of CPAP

• BiPAP should be considered when patients are uncomfortable or intolerant of high CPAP pressures 1, 3
• BiPAP is indicated when there are continued obstructive respiratory events at 15 cm H2O of CPAP during titration 1
• Patients with OSA requiring CPAP >15 cm H2O often benefit from switching to BiPAP 3, 4

Clinical Benefits of BiPAP for OSA

• BiPAP can achieve sufficient control of sleep-disordered breathing with lower expiratory pressures compared to CPAP (10 cm H2O vs 16.8 cm H2O) 3
• BiPAP may improve adherence (7.0 hours/night vs 2.5 hours/night with CPAP) in patients who fail CPAP therapy 3
• BiPAP can significantly improve sleep quality and reduce daytime sleepiness in patients who struggle with CPAP 4

Important Considerations

• Higher starting IPAP or EPAP may be selected for patients with elevated BMI and for retitration studies 1, 2
• If a patient awakens and complains that pressure is too high, restart at a lower pressure that allows return to sleep 1, 2
• Exploration of IPAP above the pressure that controls respiratory abnormalities should not exceed 5 cm H2O 1
• For patients with comorbid conditions like COPD or obesity hypoventilation syndrome, BiPAP may be more effective than CPAP for simultaneously addressing OSA and hypoventilation 3, 5