Efficacy of auto-CPAP in the treatment of obstructive sleep apnea/hypopnea syndrome

The auto-CPAP (Morphée Plus) is characterized by its ability to modify the positive-pressure level applied during the night for the presence or absence of sleep-induced respiratory disorders. The aim of the study was to compare the efficacy of this new mode of CPAP therapy with that of conventional constant-CPAP in the treatment of sleep apnea/hypopnea syndrome (SAHS). Sixteen patients with SAHS were randomly allocated to two groups that were paired for age, apnea/hypopnea index, and mean sleep latency. In the auto-CPAP group, the pressure level could change within fixed limits in both directions (+2 to -4 cm H2O) of the previously determined effective pressure level (Peff). In the constant-CPAP group, patients used the same apparatus (Morphée Plus) in a constant mode at Peff level. At the beginning of the study, the Peff level was determined during a polysomnographic recording. Day-time vigilance was measured subjectively by a standardized questionnaire and objectively by the maintenance of wakefulness test (MWT); Trailmaking tests (TMT) were used to evaluate cognitive functions. After 3 wk of home CPAP therapy, a control sleep study was done with the CPAP machine used in the protocol, and daytime vigilance and cognitive function tests were obtained. Baseline sleep and nocturnal breathing disorders characteristics did not differ between the two groups, and daytime vigilance and cognitive function abnormalities were similarily altered. In both groups, the apnea/hypopnea index was within normal range at the final CPAP sleep study. In the auto-CPAP group, 49.3 +/- 14.9% (mean +/- SD) of home treatment time was spent at a pressure < or = Peff. Home amount of use estimated by the number of sleeping hours with a positive pressure applied was 6.5 +/- 1.0 h in the auto-CPAP group and 5.1 +/- 1.1 h in the constant-CPAP group (p = 0.02). During the control CPAP sleep study, the positive pressure level was significantly lower during Stage III-IV than during the other sleep stages (p = 0.004). The improvement in the MWT and the TMT observed with CPAP therapy was identical in both groups. We conclude that (1) the amount of use during CPAP treatment is higher with auto-CPAP than with constant-CPAP, and (2) Morphée+auto-CPAP is an efficient as conventional CPAP in correcting nocturnal breathing disorders, daytime sleepiness, and cognitive impairment in SAHS.