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  • Title: Comparative study of autotitrating and fixed-pressure CPAP in the home: a randomized, single-blind crossover trial.
    Author: Hukins C.
    Journal: Sleep; 2004 Dec 15; 27(8):1512-7. PubMed ID: 15683142.
    Abstract:
    STUDY OBJECTIVES: 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. DESIGN: Randomized, single-blinded, parallel crossover study. SETTING: Tertiary referral sleep disorders center. PATIENTS: Consecutive patients with obstructive sleep apnea syndrome requiring treatment with CPAP. INTERVENTIONS: 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. MEASUREMENTS AND RESULTS: 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. CONCLUSIONS: 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.
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