Autoadjusting positive pressure trial in adults with sleep apnea assessed by a simplified diagnostic approach

To describe our clinical experience with autoadjusting positive airway pressure (APAP) trials carried out on patients with moderate-to-severe obstructive sleep apnea (OSA).

Consecutive CPAP-naive adults underwent a non-attended home APAP trial (ResMed, Autoset, Spirit). Diagnoses of OSA were established by simplified polygraphy.

Data from 208 men and 71 women. The median age (interquartile range) was 51 years (41-59), with an Epworth Sleepiness Scale score of 13.5 (9-19), body mass index of 33 kg/m2 (29-38) and respiratory disturbance index (RDI) of 53 events/h (35-74). The APAP trial results included: hours used per night, 5.5 (4-7); 95th percentile pressure, 10.6 cm H2O (9.4-11.7); 95th percentile leak, 0.3 UL/sec (0.1-0.6); residual RDI, 6.2 events/h (3.9-11.4); and percentage change in RDI, 87% (74-93). The proportion of patients with residual RDI >10 events/h was 29% (95% CI 23.6-34.3). Adherence (> 70% of nights and > 4 h/night) was observed in 72.4% of subjects (95% CI 67-78). Patients with APAP adherence tended to require higher CPAP pressures, had higher rates of residual RDI, and had a lower percentage change in RDI than those with no adherence. As the 95th percentile CPAP pressure increased so too did residual RDI.

The APAP trial was effective in decreasing RDI with an acceptable adherence rate; however, residual OSAwas a frequent finding. Our results support that in up to one-third of patients evaluated by a simplified diagnostic approach, CPAP titration based on 95th percentile pressure may not be sufficient if residual RDI < 10 events/h is considered as a therapeutic target.