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Two months auto-adjusting versus conventional nCPAP for obstructive sleep apnoea syndrome
H Teschler1, T E Wessendorf, A A Farhat
1Dept. of Pneumology/Sleep Medicine, Ruhrlandklinik, Medical Faculty, University of Essen, Germany.
The European Respiratory Journal
|July 8, 2000
Summary
Autoadjusting nasal continuous positive airway pressure (CPAP) offers comparable apnoea/hypopnoea index (AHI) reduction to fixed-pressure CPAP. This auto-adjusting CPAP therapy significantly lowers median pressure by 23% without impacting compliance.
Area of Science:
- Respiratory Medicine
- Sleep Medicine
- Biomedical Engineering
Background:
- Obstructive sleep apnea (OSA) is a common condition characterized by recurrent episodes of upper airway collapse during sleep.
- Continuous positive airway pressure (CPAP) is the gold standard treatment for OSA, but optimal pressure titration can be challenging.
- Autoadjusting CPAP (AutoSet) devices aim to provide personalized pressure delivery, potentially improving efficacy and patient comfort.
Purpose of the Study:
- To evaluate the medium-term efficacy and adherence of autoadjusting nasal CPAP compared to manually titrated fixed-pressure CPAP in a home setting.
- To assess whether the benefits of autoadjusting CPAP observed in short-term studies are maintained over a 2-month period.
- To compare the apnoea/hypopnoea index (AHI), median pressure (P50), and air leak between autoadjusting and fixed-pressure CPAP modes.
Main Methods:
- A double-blind crossover study design was employed with 10 OSA patients (mean AHI 52.9/h).
- Participants used autoadjusting CPAP for 2 months, followed by 2 months of fixed-pressure CPAP at their manually titrated level, or vice versa.
- Objective data on AHI, P50, and median leak were collected from machine records over 12 nights in each treatment arm.
Main Results:
- Autoadjusting CPAP achieved an AHI of 4.0/h, comparable to fixed-pressure CPAP (3.7/h) (p > 0.05).
- Median pressure was significantly reduced by 23% with autoadjusting CPAP (7.2 cmH2O) compared to fixed-pressure CPAP (9.4 cmH2O) (p < 0.0001).
- Median leak was lower with autoadjusting CPAP (0.181 L/s) than fixed-pressure CPAP (0.20 L/s) (p = 0.003), and compliance was similar (6.3h vs 6.1h).
Conclusions:
- Autoadjusting nasal CPAP effectively controls AHI in the medium term at home, similar to conventional fixed-pressure CPAP.
- The primary benefit of autoadjusting CPAP is a significant reduction in prescribed pressure, potentially enhancing patient comfort and tolerability.
- Air leak does not appear to significantly impede the autoadjustment mechanism in this patient cohort.