Comparative study of autotitrating and fixed-pressure CPAP in the home: a randomized, single-blind crossover trial

To compare compliance and treatment response between continuous positive airway pressure (CPAP) and auto-titrating positive airway pressure (APAP) and to develop selection criteria for the use of APAP.

Randomized, single-blinded, parallel crossover study.

Tertiary referral sleep disorders center.

Consecutive patients with obstructive sleep apnea syndrome requiring treatment with CPAP.

2-month treatment each of conventional CPAP and APAP in random order comparing objective compliance, Epworth Sleepiness Score, SF-36 Health Survey, visual-analog measures of ease of and attitude to treatment, side effects, and treatment pressures or system leaks obtained from the Autoset T device.

There were no differences between treatment modes in overall compliance (CPAP 4.86 +/- 2.65, APAP 5.05 +/- 2.38 hours per night, P = .14), Epworth Sleepiness Scale scores (baseline 12.4 +/- 5.1, CPAP 8.4 +/- 5.2, APAP 7.9 +/- 4.8, P < .001 relative to baseline, NS between modes), SF-36 scores (significant improvements in Role Physical and Vitality domains relative to baseline, P < .001 but NS between modes). There were fewer reported side effects in APAP mode (CPAP 28, APAP 15 reports, P = .02) and compliance was greater with APAP in those reporting any side effect (95% confidence interval CPAP 0-6.8, APAP 2.9-7.8 hours per night, P < .001). APAP delivered significantly lower median and 95th centile airway pressures and fewer system leaks.

Compliance, subjective sleepiness, and quality of life are similar between patients who used CPAP and APAP. APAP delivers lower pressures and results in lower-pressure leaks and fewer reported side effects. Compliance is higher with APAP in subjects reporting any side effect. APAP may be indicated in patients reporting side effects with conventional CPAP.