Use of conventional and self-adjusting nasal continuous positive airway pressure for treatment of severe obstructive sleep apnea syndrome: a comparative study. Two months auto-adjusting versus conventional nCPAP for obstructive sleep apnoea syndrome. Comparison of three ways to determine and deliver pressure during nasal CPAP therapy for obstructive sleep apnoea Constant vs. automatic continuous positive airway pressure therapy: home evaluation. Preference for fixed or automatic CPAP in patients with obstructive sleep apnea syndrome. Efficacy of Automatic Continuous Positive Airway Pressure Therapy That Uses an Estimated Required Pressure in the Treatment of the Obstructive Sleep Apnea Syndrome Equivalence of autoadjusted and constant continuous positive airway pressure in home treatment of sleep apnea. Efficacy and cost of home-initiated auto-nCPAP versus conventional nCPAP. Compliance in sleep apnoea therapy: influence of home care support and pressure mode Comparison of Automatic and Continuous Positive Airway Pressure in a Night-by-Night Analysis: A Randomized, Crossover Study Constant vs auto-continuous positive airway pressure in patients with sleep apnea hypopnea syndrome and a high variability in pressure requirement. Effects of fixed compared to automatic CPAP on sleep in Obstructive Sleep Apnoea Syndrome. Fixed and autoadjusting continuous positive airway pressure treatments are not similar in reducing cardiovascular risk factors in patients with obstructive sleep apnea. A randomized trial of auto-titrating CPAP and fixed CPAP in the treatment of obstructive sleep apnea-hypopnea. Comparison between automatic and fixed positive airway pressure therapy in the home. Randomized short-term trial of two autoCPAP devices versus fixed continuous positive airway pressure for the treatment of sleep apnea. Comparative study of autotitrating and fixed-pressure CPAP in the home: a randomized, single-blind crossover trial. Evaluation of autoCPAP devices in home treatment of sleep apnea/hypopnea syndrome. Autoadjusting CPAP therapy based on impedance efficacy, compliance and acceptance. A long-term randomized, cross-over comparison of auto-titrating and standard nasal continuous airway pressure. Automatic Pressure Titration with APAP Is as Effective as Manual Titration with CPAP in Patients with Obstructive Sleep Apnea Randomized controlled trial of variable-pressure versus fixed-pressure continuous positive airway pressure (CPAP) treatment for patients with obstructive sleep apnea/hypopnea syndrome (OSAHS). Auto-adjusting versus fixed positive pressure therapy in mild to moderate obstructive sleep apnoea.
STUDY OBJECTIVES To compare conventional and self-adjusting nasal continuous positive airway pressure ( nCPAP ) therapy in patients with severe obstructive sleep apnea syndrome with respect to suppression of respiratory disturbances , quality of sleep , mean mask pressure , and patient compliance . DESIGN Cohort study of consecutive patients with obstructive sleep apnea syndrome , single-blinded . SETTING Clinical sleep laboratory in Germany . PATIENTS Fifty patients ( 44 men , 6 women who ranged in age from 35 to 71 years ) with polysomnographically confirmed severe obstructive sleep apnea syndrome ( respiratory disturbance index [ RDI ] , > 20/h ) . MEASUREMENTS AND INTERVENTIONS After baseline polysomnography , patients were r and omly treated with nCPAP either in conventional ( group 1 ) or in automatically adjusting ( group 2 ) mode . Three to 6 months after adjustment , all patients underwent polysomnography again . They also were examined with a portable monitoring device and received a question naire on subjective well-being and device evaluation . RESULTS Anthropometric and respiratory data were comparable in both groups ; body mass index had not changed significantly in the follow-up . RDI dropped by 91.5 % ( from 38.3+/- 13.9/h to 3.6+/-4.4/h ) in conventional and by 93.6 % ( from 35.5+/-9.6/h to 2.4+/-1.6/h ) in self-adjusting mode ( statistically not significant [ NS ] ) . Sleep efficiency decreased by 4.0 % in conventional and increased by 2.0 % in self-adjusting mode ( NS ) . In both groups , normal sleep structure was largely restored . Mean mask pressure was 8.1+/-2.5 cm H2O in group 1 and 6.5+/-1.7 cm H2O in group 2 ( p<0.01 ) . Patient compliance in terms of nights per week of mask appliance was better in the self-adjusting mode ( 5.7+/-0.7 to 6.5+/-0.4 ; p<0.01 ) . CONCLUSION Self-adjusting nCPAP demonstrates the same reliability in suppression of respiratory disturbances as fixed-mask pressure therapy .  Sleep quality is slightly superior , patient compliance is highly significantly better Autoadjusting  nasal continuous positive airway pressure ( CPAP )  greatly reduces the apnoea/hypopnoea index ( AHI ) , and affords a significant reduction in median pressure ( P50 ) compared-with manually titrated conventional nasal CPAP . The aim of the present study was to test whether these benefits were maintained in the medium term at home , in a double-blind crossover study . Ten sequential subjects ( mean AHI 52.9 x h(-1 ) ) were enrolled . After a manual titration , subjects were r and omly allocated to 2 months autoadjusting nasal CPAP ( AutoSet ) , followed by 2 months with the AutoSet device in fixed pressure mode at the manually titrated pressure , or vice versa . The machine-scored AHI , P50 , and median leak were recorded on 12 nights in each arm , and averaged . Mean+/-SEM AHI was 4.0+/-0.3 x h(-1 ) in auto mode , and 3.7+/-0.3 x h(-1 ) in manual mode ( NS ) . Mean+/-SEM P50 was 7.2+/-0.4 cmH2O auto , 9.4+/-0.6 cmH2O manual , average reduction 23+/-4 % ( p<0.0001 ) . Auto " recommended " pressure was ( mean+/-SEM ) 10.1+/-0.5 cmH2O ( p=0.04 with respect to manual ) and peak pressure typically 1 cmH2O higher . Median ( + /-SEM ) leak was 0.181+/-0.006 L x s(-1 ) auto ( and uncorrelated with AHI or pressure ) , 0.20+/-0.006 L x s(-1 ) manual ( p=0.003 ) . Compliance was 6.3+/-0.4 h in auto mode and 6.1+/-0.5 h in fixed mode ( NS ) . Apnoea/hypopnoea index during 2 months of home autoadjusting nasal continuous positive airway pressure is comparable to that during conventionally titrated fixed pressure continuous positive airway pressure , while affording a 23 % reduction in median pressure but no increase in compliance . Leak did not importantly affect autoadjustment Background : The simplest method of initiating and maintaining therapeutic continuous positive airways pressure ( CPAP ) therapy for obstructive sleep apnoea ( OSA ) has not been established . Methods : Ninety eight subjects with OSA requiring CPAP treatment ( more than 10 dips in oxygen desaturation of > 4 % per hour of sleep study and Epworth Sleepiness Score ( ESS ) > 9 ) were r and omised prospect ively to three different methods of CPAP delivery for 6 months : ( 1 ) autotitration pressure throughout ; ( 2 ) autotitration pressure for 1 week followed by fixed pressure ( 95th centile ) thereafter ; and ( 3 ) fixed pressure determined by algorithm ( based on neck size and dip rate ) . Patients and investigators were blind to group allocation . One week after initiation the patients were routinely review ed by sleep nurses . Study assessment s took place before starting CPAP treatment and 1 and 6 months after to assess ESS , maintenance of wakefulness test , 24 hour blood pressure , general health ( SF-36 ) , and sleep apnoea related quality of life . CPAP internal monitoring data were also collected . Results : There were no significant differences in any of the outcome measures or CPAP monitoring data between the three groups . The 95th centile CPAP pressures delivered in the 6 month and 1 week autotitration groups were higher than in the algorithm group , but the median pressures were lowest in the 6 month autotitration group . Conclusions : The method of determining CPAP pressure for treatment of moderate to severe OSA makes no significant difference to clinical outcome measures . The autotitration CPAP machine used has no advantage in this setting over simpler methods of pressure determination STUDY OBJECTIVES To compare the efficacy and patient tolerance , compliance , and preference between auto-continuous positive airway pressure ( CPAP ) and constant CPAP . DESIGN Single-blinded , crossover , cohort study of consecutive patients with obstructive sleep apnea syndrome , with two treatment periods of 2 months each . PATIENTS Twenty-five patients ( 22 men , 3 women ) with sleep apnea syndrome confirmed by ambulatory polysomnography . MEASUREMENTS AND INTERVENTIONS After baseline polysomnography , patients underwent in-laboratory polysomnography for titration of constant CPAP . The order of treatment was r and omly allocated , either auto-CPAP and then constant CPAP , or vice versa . The auto-CPAP pressure range was 6 to 16 cm H(2)O. At the end of each 2-month period , patients underwent a control ambulatory polysomnography and received a question naire on subjective well-being and device evaluation . Duration of use was checked through CPAP device monitoring . RESULTS No differences were found in apnea/hypopnea index ( constant CPAP , 9.7+/-1.9 events/h vs auto-CPAP , 10.6+/-9.3 events/h ) , awakening/arousal index ( constant CPAP , 13.7 + /- 8.0 events/h vs auto-CPAP , 15.5 + /- 8.9 events/h ) , slow-wave sleep duration , nocturnal saturation , or complaint of daytime sleepiness . The mean pressure required was significantly lower during auto-CPAP than during constant CPAP ( 8.8+/-1.8 cm H(2)O vs. 9.7+/-2.6 cm H(2)O , respectively ) . Patient tolerance , compliance , and duration of use were similar with both treatments . CONCLUSIONS Auto-CPAP is as effective as constant CPAP . A wide pressure range for auto-CPAP can be used in all patients , suggesting that , in the future , use of a broad pressure range in the auto-CPAP mode could obviate the need for the titration night BACKGROUND The aims of this study were to compare compliance to treatment with fixed CPAP and with autoCPAP , subjective preference for type of CPAP treatment , and factors associated to preference for autoCPAP in patients with OSAS . PATIENTS AND METHODS Twenty-two subjects were studied in a r and omized , single blind cross-over fashion . They were treated for one month by fixed CPAP ( Elite Sullivan V , ResMed , Sydney , Australia ) and one month by autoCPAP ( Autoset T , ResMed , Sydney , Australia ) . RESULTS Four subjects who stated a preference for fixed CPAP and four who expressed no preference were pooled together ; fourteen preferred autoCPAP .  Compliance to treatment using the two machines did not differ in the first group ( 3.8 ( 1.9 ) vs. 3.8 (1.5)h/day , fixed vs autoCPAP ) , but was higher with autoCPAP in the second group ( 4.8 ( 1.8 ) vs 5.5 (1.5)h/day , P<0.05 ) . Baseline apnea/hypopnea index ( AHI ) was high in both groups , but was higher in the second group P<0.02 . First treatment was always  fixed CPAP  in patients who preferred fixed CPAP , while it was either in the other subjects . CONCLUSIONS Compliance to autoCPAP differs among OSAS patients . As long as factors predicting higher compliance to autoCPAP are not found , a trial with autoCPAP in patients poorly compliant to fixed CPAP may be warranted The obstructive sleep apnea syndrome ( OSAS ) is highly prevalent ; it is found in 4 % of middle-aged men and 2 % of middle-aged women [ 1 ] . The increase in the rate of illness and death associated with this disease emphasizes the need for effective treatment [ 2 - 5 ] . Approaches to therapy include weight loss [ 6 ] , upper airway surgery [ 7 ] , oral appliances [ 8 ] , and nasal continuous positive airway pressure ( CPAP ) [ 9 ] . Therapy with CPAP decreases the rate of illness and death associated with sleep apnea [ 5 , 10 , 11 ] . Before CPAP therapy is started at home , a polysomnographic study must be done to determine the pressure needed to resolve apnea , hypopnea , snoring , and respiratory-related arousals in all sleep stages and body positions . The CPAP device is then set to this level . Effective pressure can also be estimated by using a regression model that takes into account anthropometric characteristics , neck circumference , and the frequency of nocturnal breathing abnormalities [ 12 ] . However , the regression model often underestimates the positive pressure requirements . A recent report [ 13 ] suggested that effective pressure can be reliably estimated during unattended sleep studies by using automatic adjustments of the positive pressure made on the basis of a record of respiratory variables . Because the optimal CPAP comprises several factors , the effective pressure can change within one night and from one night to another depending on changes in body position [ 14 , 15 ] , sleep stage [ 14 ] , neck and m and ibular position [ 16 , 17 ] , nasal patency , upper airway edema [ 18 ] , and other factors . This variability has led to the development of automatic CPAP devices that continuously adapt the positive pressure in response to varying needs . We compared the efficacy of conventional CPAP therapy with that of automatic CPAP therapy administered by an automatic CPAP machine ( Morphee Plus , Pierre Medical , Verrieres-Le-Buisson , France ) for OSAS [ 19 ] . With this machine , the user must establish a reference pressure that usually corresponds to the effective pressure determined by a conventional titration sleep study . However , the effective pressure can be estimated by the user 's characteristics ; we hypothesized that the ability of the automatic CPAP machine to automatically adjust the positive pressure should compensate for the uncertainty in effective pressure determination obtained by the regression model . This procedure may provide effective treatment of OSAS without doing a CPAP titration sleep study . We compared the efficacy of automatic CPAP given at an estimated reference pressure , automatic CPAP given at a measured reference pressure , and conventional CPAP therapy . Methods Patients The study was conducted between 30 May 1995 and 16 May 1996 . Thirty-nine patients were asked to participate , but 3 refused to participate because of their work schedules . Therefore , 36 patients ( age range , 36 to 65 years ; mean body mass index SD , 36.4 7.6 kg/m2 ) with previously untreated OSAS were included . All patients were seen at the sleep clinic at Hopital Laval . A diagnosis was made on the basis of clinical features and was confirmed by a polysomnographic study ( mean apnea + hypopnea index [ events per hour ] SD , 43.6 19.8 ) . After this diagnostic study , all patients who chose to be treated with nasal CPAP and had no exclusion criteria were asked to participate in the study . Patients were excluded if they had life-threatening forms of OSAS ( such as severe hypersomnolence ) that required immediate treatment , OSAS associated with nonobstructive sleep-related breathing disorders ( such as periodic breathing and hypoventilation ) or with nonrespiratory sleep disorders ( such as narcolepsy and periodic leg movements ) , or an estimated pressure above 15 cm H2O . Treatment with Continuous Positive Airway Pressure A titration sleep study was conducted within 1 week after the diagnostic sleep study to determine the effective pressure in all patients . Patients were then r and omly assigned to one of three treatment groups in a single-blind fashion . The Morphee Plus automatic CPAP device will soon be distributed in North America by Nellcor Puritan-Bennett ( Eden Prairie , Minneapolis , Minnesota ) under the name of Cloudnine . The device has not yet been approved by the U.S. Food and Drug Administration . Because the Morphee Plus device can be set to a constant or an automatic CPAP mode , we used this machine to treat the three groups . In the automatic CPAP mode , the positive pressure is allowed to change within a determined range around the reference pressure . The reference pressure and the upper and lower pressure thresholds are chosen separately by the physician . Group 1 was treated with conventional CPAP ; that is , a constant pressure was set at the effective pressure . For groups 2 and 3 , the machine was used in the automatic CPAP mode ; the reference pressure was set at the measured effective pressure for group 2 and at the estimated effective pressure for group 3 . The estimated effective pressure was calculated by using the following formula [ 12 ] : ( Equation 1 ) We set the range of pressure at 3 cm H2O above the reference pressure to 4 cm H2O below the reference pressure in accordance with our previous experience with this machine [ 19 ] and the level of underestimation reported with the estimated pressure formula [ 12 ] . Patients were blinded to treatment assignment . For each block of three patients , the treatment regimen was determined by using a r and omization table . To compare patients with similar severity of disease , patients were paired for the estimated pressure value . In each block of three patients , the estimated pressure could not differ by more than 1 cm H2O from the value of the first patient included in that block . If a c and i date did not meet this criterion , he or she was assigned to the first r and omized position in the next block of three patients . Characteristics of Automatic Continuous Positive Airway Pressure In the automatic CPAP mode , the positive pressure is maintained as long as ventilation remains stable ; however , any respiratory disorder results in a progressive increase in the pressure . If a breathing disturbance has not occurred for more than 4 minutes , the positive pressure decreases again . Changes in pressure are regulated by a constant feedback analysis of the patient 's ventilation by the nasal CPAP device . The breath-by-breath difference between maximal inspiratory and expiratory flow is estimated by the changes in compressor speed required to maintain a constant positive pressure throughout the respiratory cycle . Apneic and hypopneic events are associated with a decrease in the difference between the inspiratory and expiratory flow ; this leads to an increase in the pressure until the flow regimen of the compressor has become stable or the fixed upper limit of pressure has been reached . Outcome Measures Sleep and breathing characteristics were measured during polysomnographic studies that consisted of continuous electroencephalography [ C4/A1 , C3/A2 , O2/A1 , and O1/A2 ] , submental electromyography , electrooculography , and electrocardiography and measurement of 1 ) nasobuccal airflow by thermistors , 2 ) thoracoabdominal movements by inductive plethysmography  [ Respitrace , Ambulatory Monitoring , Inc. , Arsdley , New York ] , 3 ) arterial oxyhemoglobin saturation ( Sao 2 ) level with an ear oximeter [ 504 Pulse oximeter , Criticare Systems , Inc. , Waukesha , Wisconsin ] , and 4 ) breathing noises by two microphones placed at the bedside . All variables were recorded on a computer ( S and man , Melleville Diagnostics , Ottawa , Ontario , Canada ) . Polysomnographic recordings were manually interpreted in 30-second periods according to established criteria [ 20 ] . Arousals were scored according to the definition established by the American Sleep Disorders Association [ 21 ] . Apnea was defined as the cessation of nasal-oral airflow for at least 10 seconds . Hypopnea was defined as a decrease of more than 50 % in total thoracoabdominal movements for at least 10 seconds and was associated with a 2 % decrease in Sao 2 level or an arousal . Diurnal somnolence was assessed by using the Epworth Sleepiness Scale [ 22 ] and maintenance-of-wakefulness tests [ 23 ] . For the latter , patients were seated in a comfortable armchair every 2 hours and asked to remain awake as long as possible during four consecutive 40-minute periods in darkness . Each maintenance-of-wakefulness test was stopped after 10 minutes of sleep or after 40 minutes if no sleep was recorded ; sleep onset was defined as three continuous periods of stage I sleep , any period of stage II to IV or rapid eye movement sleep . Sleep latency was defined as the mean value of the four tests . The mean positive pressure , the proportion of time spent at different pressures , and the time at which positive pressure was applied were automatically recorded each night by the CPAP device for 3 weeks . Changes in positive pressure were analyzed during the control sleep study by continuous recording of mask pressure . Compliance with CPAP therapy  was assessed by measuring the amount of CPAP used during the study period and was quantified by measuring the percentage of time during which the machine was turned on and positive pressure was applied ( effective pressure-time index ) and the number of nights during which positive pressure was applied for more than 4 hours and more than 7 hours [ 24 ] . After 3 weeks of treatment with CPAP , a control sleep study was done by using the CPAP device on the setting that patients had used for the past 3 weeks . The Epworth Sleepiness Scale and maintenance-of-wakefulness tests were completed at baseline and on the day after the third polysomnographic recording . Time and pressure readings were printed from the machine at the end of the study period . Changes in the apnea + hypopnea index and diurnal hypersomnolence after CPAP therapy and differences in compliance with CPAP therapy among the three treatment groups were the main study end points . Whether computerized autoadjusted continuous positive airway pressure ( aCPAP ) is effective or even superior to constant continuous positive airway pressure ( cCPAP ) in the treatment of obstructive sleep apnea syndrome ( OSAS ) is still controversial . We performed a r and omized , double-blind , controlled , cross-over trial comparing efficacy of sleep apnea home therapy by a novel aCPAP machine ( REMStarAuto ; Respironics ; Murrysville , PA ) operated in autoadjusted or constant mode . Thirty sleep apnea patients were recruited consecutively . Mean baseline Epworth sleepiness scale ( ESS ) score was 12.7 + /- 0.6 ( + /- SD ) , mean sleep resistance time was 26 + /- 2 min ( Osler test ; Stowood Scientific Systems ; Oxford , UK ) , and mean apnea-hypopnea index ( AHI ) was 41.1 + /- 3.6 h. Patients were r and omly assigned to 1 month of home therapy with aCPAP followed by 1 month with cCPAP , or vice versa . After 1 month with treatment , the mean ESS score , sleep resistance time , and AHI were significantly improved ( 6.6 + /- 0.6 , 37 + /- 1 min , and 4.6 + /- 0.7 h , respectively ; all p < 0.05 vs baseline ) . Similar effects were achieved with cCPAP ( p = not significant vs aCPAP ) . Twenty-six patients preferred aCPAP , and 4 patients preferred cCPAP ( p < 0.001 ) . We conclude that patients with OSAS preferred aCPAP over cCPAP in the initial phase of therapy . The effectiveness aCPAP in improving major outcomes was equivalent to cCPAP . Since aCPAP does not require initial titration , it is a simple and promising modality for sleep apnea home therapy STUDY OBJECTIVES To compare in a multicenter prospect i ve study the efficacy and cost of conventional nasal continuous positive airway pressure ( nCPAP ) initiated at the sleep laboratory versus auto-nCPAP initiated at home . DESIGN Patients with severe obstructive sleep apnea syndrome ( OSAS ) were r and omized to treatment with either the REM+ auto device in constant mode at the effective pressure determined by titration at the sleep laboratory ( n=17 ) or the REM+ auto device in automatic mode initiated at the patients home by a nurse ( n=18 ) . After 2 months , the efficacy and cost of nCPAP therapy and the time from diagnosis to nCPAP were evaluated . All values are reported as means + /- SD . PATIENTS Thirty-five subjects with newly diagnosed OSAS ( 8 women and 27 men , mean age : 54.3 + /- 10.6 years , apnea-hypopnea index ( AHI ) 58.1 + /- 14.0 h(-1 ) ) . INTERVENTIONS N/A. MEASUREMENTS AND RESULTS Both treatments were used properly and induced similar decreases in the AHI ( 7.6 + /- 6.9 vs. 10.4 + / -12.5 h(-1 ) for auto-nCPAP and conventional nCPAP , respectively ; NS ) and Epworth Sleepiness score ( from 15.5 + /- 4.7 to 7.5 + /- 3.4 vs. 14.7 + /- 3.9 to 7.6 + /- 3.4 for auto-nCPAP and conventional nCPAP , respectively ; NS ) . With auto-nCPAP initiated at home , the time from diagnosis to final adjustment of nCPAP  was shorter ( 16.3 + /- 5.0 vs. 47.2 + /- 46.5 days with conventional nCPAP , P < 0.02 ) and the cost was lower ( 1,263 + /- 352 vs. 1720+/-455 E , respectively ; P < 0.05 ) . CONCLUSIONS Treatment of OSAS with auto-nCPAP initiated at home is effective and reliable and reduces the time from diagnosis to therapy and the cost of treatment Continuous positive airway pressure ( CPAP ) is an effective treatment for obstructive sleep apnoea syndrom ( OSAS ) but therapy adherence is often low . The hypothesis that CPAP-adherence and clinical outcomes can be improved by either using an autoadjusting-CPAP ( APAP ) device or an intensive support was tested . A controlled parallel group study was performed with 100 newly diagnosed OSAS patients , r and omised into 4 groups ( n = 25 each ) : st and ard or intensive support plus either APAP or CPAP . Intensive support included education and monthly home visits for 6 months . Clinical outcome was monitored by polysomnography at CPAP initiation and , after 3 and 9 months , compliance data were downloaded from the CPAP devices . After 9 months , intensively supported patients returned for follow-up in 88 versus 68 % in the st and ard-support-group . Daily usage ( mean±sem 5.7±0.2 for intensive support versus 4.6±0.4 h for st and ard support ) , percentage of days used ( 80.4±2.8 versus 57.0±5.9 % ) and proportion of individual sleep time ( 80.6±3.2 versus 64.9±6.2 % ) were also higher . There was no significant difference  between APAP or CPAP , ( daily usage 5.2±0.4 versus 5.1±0.3 h , percentage of days 67.9±5.0 versus 69.2±4.9 % , proportion of sleep time 72.5±5.0 % versus 72.1±5.2 % , for APAP and CPAP ) but retention rate was higher with CPAP . In summary , intensive support after continuous positive airway pressure initiation , rather than the application of autoadjusting-continuous positive airway pressure , increased therapy adherence Background : Long-term compliance is suboptimal in the treatment of the obstructive sleep apnea syndrome ( OSAS ) . Objectives : We compared the efficacy of and the adherence to automatic continuous positive airway pressure ( APAP ) and constant continuous positive airway pressure ( CPAP ) based on a night-by-night analysis . Methods : We performed a r and omized , single-blind crossover study in 20 patients with moderate-to-severe OSAS . After diagnostic polysomnography and manual titration , patients were treated for 8 weeks with both constant CPAP and APAP in r and om order . Compliance and leakage were analyzed night by night using the software LOGSoft ® of the Magellan ® iPAP device . Results : The reduction in the apnea/hypopnea index ( baseline 32.9 ± 19.1/h , CPAP 4.6 ± 2.9/h , APAP 5.6 ± 3.6/h ; p < 0.001 compared to baseline ) and the Epworth Sleepiness Scale ( baseline 10.3 ± 5.7 , CPAP 6.6 ± 4.8 , APAP 4.9 ± 4.6 ; p < 0.001 compared to baseline ) did not significantly differ between the treatment modes . Leakage time and compliance per night were not statistically different ( leakage CPAP 31 ± 57 min , APAP 25 ± 49 min ; compliance CPAP 383 ± 116 min , APAP 382 ± 107 min ) . There was no correlation between leakage and compliance . Thirteen patients ( 65 % ) preferred APAP at the end of the study . Conclusions : Treatment efficacy and adherence are similar with CPAP and APAP . There is a trend towards lower leakage with APAP therapy . Patients prefer the automatic mode to fixed pressure STUDY OBJECTIVES Auto-continuous positive airway pressure ( CPAP ) has been reported to have no more efficacy than constant CPAP in unselected patients with sleep apnea hypopnea syndrome ( SAHS ) . The aim of this study was to evaluate patients judged to be good c and i date s for auto-CPAP  because of a high within-night variability in pressure requirement . DESIGN Single-blind , r and omized , cross-over study ( 2 x 8 weeks ) to compare auto-CPAP with constant CPAP . PATIENTS Out patients with moderate-to-severe SAHS attending the chest clinic . INTERVENTIONS Patients were equipped at home in the auto-CPAP mode ( model GK418A ; Malinckrodt ; Nancy , France ) , using a 4- to 14-cm H(2)O pressure range . Those individuals having a high within-night variability in pressure requirement , assessed at the end of a 14-day run-in period , were included in the cross-over study . Auto-CPAP was compared with constant CPAP ( according to a titration night in the sleep laboratory ) in terms of compliance , efficacy on apneas ( assessed from the pressure monitor ) , and sleepiness ( assessed on the Epworth sleepiness scale ) . MEASUREMENTS AND RESULTS Of 90 consecutive patients with SAHS , 27 patients were selected for a within-night variability in pressure requirement exceeding a given threshold . After completion of the cross-over , 24 patients were evaluable . The median percentage of nights the machine was used was 95.5 % ( range , 45 to 100 % ) on constant CPAP , and 96.5 % ( range , 40 to 100 % ) on auto-CPAP ; the median apnea index recorded by the device was 0.40/h ( range , 0 to 2.40/h ) on constant CPAP , and 0.45/h ( range , 0 to 5.80/h ) on auto-CPAP ( differences not significant ) . The mean Epworth sleepiness score was significantly ( p < 0.01 ) lower on auto-CPAP ( 5.1 ; SD , 2.8 ) than on constant CPAP ( 6.1 ; SD , 2.8 ) . CONCLUSIONS In patients selected for a high within-night variability in pressure requirement , auto-CPAP administered via a GK418A device was equivalent to constant CPAP based on a titration night in the sleep laboratory . Subjective ratings for sleepiness were slightly lower on auto-CPAP BACKGROUND Automatic CPAP has been developed to improve CPAP efficiency and compliance . Continually matching the effective pressure may be associated to more frequent arousals that could disturb sleep . The aim of the present study was to compare sleep architecture after one month 's home therapy with CPAP or with an AutoCPAP device . METHODS Twenty OSAS patients ( 18 M / 2 F ) after polysomnographic study with CPAP titration  received either an automatic ( AutoSet T , ResMed , Sydney , Australia ) or a fixed level CPAP machine in a r and om , single blind fashion for one month . At the end of the home treatment period polysomnography was repeated while CPAP was administered by the same machine used at home . RESULTS There was no significant difference between groups in terms of age ( 50.0 vs 45.5 , NS ) , sex , BMI ( 38.3 vs 35.1 , NS ) , RDI ( 45.4 vs 48.0 , NS ) , and CPAP effective level ( 9.8 vs 10.8 , NS ) . After one month of therapy the correction of sleep respiratory disturbances and of sleep structure was satisfactory in both groups . No difference in any polysomnographic variable or in subjective sleepiness was found at re-evaluation . CONCLUSIONS The results of this study demonstrate that on average CPAP administered by a fixed CPAP machine and by the AutoSet T autoCPAP device has similar effects in improving respiratory function during sleep , nocturnal sleep architecture , and subjective daytime sleepiness after a one-month therapy . As autoCPAP devices are more expensive than fixed CPAP machines , their prescription should be considered only after a clear demonstration of an increase in compliance to treatment by these devices BACKGROUND A strong association between obstructive sleep apnea ( OSA ) and the risk for cardiovascular and cerebrovascular diseases has been reported . Continuous positive airway pressure ( CPAP ) is the first-line therapy for OSA , able not only to reduce daytime sleepiness but also to improve cardiovascular and metabolic outcomes . Autoadjusting CPAP ( APAP ) , an alternative treatment to CPAP , can reduce OSA symptoms while increasing long-term CPAP compliance without the high costs of CPAP titration . However , no data are available on the effects of APAP on cardiovascular risk factors METHODS We performed st and ard full polysomnography ; obtained plasma levels of glucose , insulin , and C-reactive protein ( CRP ) ; and measured systolic BP ( SBP ) and diastolic BP ( DBP ) in 31 patients with newly diagnosed , severe OSA . After st and ard CPAP titration , all subjects were r and omized to CPAP or APAP treatment . Measurements were obtained at baseline and after 3 months of treatment . RESULTS The two groups were similar in terms of age , sex , body mass index ( BMI ) , and severity of OSA . SBP , DBP , heart rate ( HR ) , homeostasis model assessment index ( HOMA-IR ) , and CRP were similar in the two groups . After 3 months of treatment , BMI , HR , and compliance to therapy were also comparable . OSA indexes were significantly reduced in both groups . Significant reductions in SBP , DBP , and HOMA-IR were observed in the CPAP group but not in the APAP group , while CRP plasma levels were similarly reduced . CONCLUSIONS Our results suggest that CPAP and APAP , despite significant effects on OSA indexes and symptoms , do not improve cardiovascular risk factors in the same fashion BACKGROUND Continuous positive airway pressure ( CPAP ) remains the treatment of choice for obstructive sleep apnea hypopnea ( OSAH ) .  Auto-titrating CPAP ( APAP ) devices automatically adjust pressure and may improve treatment compliance compared to fixed CPAP ( F-CPAP ) . METHODS R and omized , prospect i ve , single-blind , crossover trial to compare efficacy , side effects , compliance , patient satisfaction and preference between APAP and F-CPAP therapy in patients with moderate to severe OSAH . There were two treatment periods of 4 weeks each ( APAP and F-CPAP ) , separated by a 2-week washout period . RESULTS Ten CPAP-naive OSAH patients ( 9 males ) completed the study . They had Mean + /- SD age of 44.9 + /- 9.7 years ; body mass index of 35.9 + /- 12.9 kg/m2 and apnea/hypopnea index ( AHI ) of 47.2 + /- 35.6 . Both forms of therapy were equally effective in improving the symptoms and in reducing the AHI . Both forms of therapy were associated with frequent side effects and had similar patient compliance . At the end of the study , more patients ( 6 - 1 ) preferred F-CPAP to A-CPAP therapy . CONCLUSION A-PAP was as effective as F-CPAP in the treatment of OSAH but was not associated with fewer side effects , better compliance , better satisfaction or increased patient preference We tested the hypothesis that continuous positive airway pressure ( CPAP ) use and outcomes can be improved by an autotitrating CPAP device in patients with obstructive sleep apnea-hypopnea syndrome ( OSAHS ) who require higher CPAP ( 10 cm H2O or more ) . In this multisite r and omized single-blind cross-over study , 44 patients ( mean age , 49 + /- 10 years ) were r and omized to 6 weeks at laboratory-determined fixed pressure and 6 weeks on autotitrating CPAP . Average nightly use was greater in automatic mode ( 306 versus 271 minutes , p = 0.005 ) ; median and 95th centile pressures in automatic mode were lower ( p < 0.002 ) . Automatic CPAP result ed in better SF-36 Vitality scores ( 65 + /- 20 versus 58 + /- 23 , p < 0.05 ) and mental health scores ( 80 + /- 14 versus 75 + /- 18 , p < 0.05 ) , but no significant difference in Epworth score ( p = 0.065 ) . During automatic therapy , patients reported more restful sleep , better quality sleep , less discomfort from pressure , and less trouble getting to sleep for both the first week of therapy and for the averaged scores for Weeks 2 - 6 ( all p values < 0.006 ) . Patients who require higher fixed CPAP use autotitrating CPAP more and report greater benefit from this therapy We evaluated the efficacy of two different continuous positive airway pressure devices with automatic mask pressure adjustment ( autoCPAP ) in comparison with fixed CPAP in treating  obstructive sleep apnea syndrome in 29 patients . The mean ( + /- SE ) apnea-hypopnea index was 46 + /- 4 per hour and the Epworth score was 14.2 + /- 0.7 . Patients were treated over three consecutive 1-month periods with three regimens in r and om order : an autoCPAP device responding to apnea-hypopnea and snoring , another autoCPAP device responding to snoring and changes in flow contour , and fixed CPAP at the 90th pressure percentile titrated by autoCPAP over 2 weeks . Allowed pressure in the autoCPAP mode was 4 to 15 cm H2O . At the end of each treatment period , symptoms , quality of life , vigilance , and nocturnal breathing disturbances were evaluated . All three treatment modalities improved symptoms , quality -of-life domains , and apnea-hypopnea index significantly and to a similar degree . Mean ( + /- SE ) maintenance-of-wakefulness time increased by 4.5 + /- 1.8 , 6.0 + /- 1.5 , and 6.1 + /- 1.4 minutes with DeVilbiss AutoAdjust LT , AutoSet T , and fixed-pressure CPAP , respectively ( p<0.001 vs. baseline , p = not significant for comparisons among the three modalities ) . We conclude that both autoCPAP devices were equally effective as fixed-pressure CPAP in improving major outcomes during short-term therapy of sleep apnea 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 R and omized , 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 r and om 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 BACKGROUND AND PURPOSE Quality of life ( QOL ) and sleepiness for patients with sleep apnea/hypopnea syndrome ( SAHS ) might improve with continuous positive airway pressure devices working in auto-adjust mode ( autoCPAP ) by allowing pressure modulations following patient needs . Clinical comparisons between devices driven by different algorithms are needed . METHODS We compared the clinical effectiveness of fixed pressure CPAP and four different autoCPAP devices by assessing compliance and QOL ( 36-item short-form health survey [ SF-36 ] ) .  SAHS patients were r and omly allocated to five groups .  Polysomnography ( PSG )  was performed to titrate the effective pressure in the constant CPAP group and evaluate residual apnea/hypopnea index ( AHI ) under autoCPAP . Follow-up consisted of clinical visits at three and six months by homecare technicians who assessed compliance , symptom scores and SF-36 scores . A laboratory-based PSG using the same CPAP/autoCPAP device as at home was performed at six months . RESULTS Eighty-three patients ( mean age 56+/-10 yrs ) with mean body mass index ( BMI ) 30.8+/-5.3 kg/m(2 ) and severe SAHS ( mean AHI : 52.3+/-17.8/h ) were included . There were no differences in clinical symptoms or QOL scores , and similar clinical and PSG improvements were seen in all groups . CPAP use was > 5 h per night , without any significant difference between groups . CONCLUSIONS AutoCPAP is equally as effective as fixed CPAP for long-term home treatment in severe SAHS patients Constant continuous positive airway pressure ( CPAP ) is the treatment of choice for the obstructive sleep apnea syndrome ( OSAS ) . To enable the pressure to be matched more accurately to actual requirements , and thus increase patient acceptance , an autoadjusting device based on the measurement of upper airway impedance was developed ( APAP(FOT ) ) . We investigated the efficacy and compliance in continuous use at home . Fifty-two patients were treated ( r and omized crossover ) with CPAP and APAP(FOT ) for 6 wk each . Respiratory disturbances , sleep profile , and arousals improved significantly with both modes ( AHI : baseline , 35.1 + /- 26/h ; APAP(FOT ) , 5.0 + /- 5.2 ; CPAP , 4.3 + /- 6.3 ; p < 0.001 baseline versus each mode ) . The mean pressure with APAP(FOT ) was significantly reduced as compared with CPAP ( CPAP , 7.8 + /- 1.5 cm H2O ; APAP(FOT ) , 5.7 + /- 1.8 cm H2O ; p < 0.001 ) . Under APAP(FOT ) the pressure was lower than that under CPAP for 81.5 + /- 21 % of the time . Although overall use did not differ , 75 % of the patients preferred APAP(FOT ) for home treatment . We conclude that APAP(FOT ) is as efficacious as constant CPAP in the treatment of OSAS . The treatment pressure can be reduced significantly , and sleep microstructure improved with APAP(FOT ) . These might be the reasons for patient preference of automatic therapy This study is a 12-week r and omized , cross-over , single-blind comparison of the tolerance , compliance , and symptomatic improvement obtained with st and ard nasal continuous positive airway pressure ( CPAP ) vs. an auto-titrating , self-adjusting device ( APAP ) .  Sixty newly diagnosed patients , 53 with obstructive sleep apnea ( OSA ) and seven with upper airway resistance syndrome were studied . Thirty-nine patients ( 65 % ) completed the 24-week protocol . Data were complete in 33 . In these 33 patients CPAP and APAP reduced the Epworth Sleepiness score from 15+/-1 ( + /-SEM ) to 8+/-1 and 9+/-1 respectively ( both < 0.0001 from baseline but NS between modes ) . The APAP average pressure was lower than the CPAP pressure , 6.4+/-0.4 and 10.6+/-0.4 cm H20 , respectively . The average daily machine use was greater with APAP , 6.0+/-0.3 hrs . versus 5.5+/-0.3 hrs . with CPAP ( P < 0.04 ) . The number of days of machine use , and the pattern of use were not different between CPAP and APAP . A higher proportion of patients who did not complete the study was r and omized to CPAP for their initial treatment period . This study showed that : 1 ) CPAP and APAP produced an equivalent improvement in daytime sleepiness , 2 )  APAP pressure was lower than CPAP pressure , 3 ) patients wore the APAP device longer during nights they used the pressure support system , and 4 ) patients who began the study with APAP were more prone to continue treatment . We conclude that APAP was better tolerated and used a greater number of hours than CPAP , but the extent of improvement in excessive daytime sleepiness was similar between the two modes of therapy Background : The optimal approach to initiate positive-pressure therapy in patients with obstructive sleep apnea is still debated . Current options are autotitrating positive airway pressure ( APAP ) or manual titration with continuous positive airway pressure ( CPAP ) . Procedures differ by parameters and by algorithms used for adapting pressure . Objectives : To evaluate the efficacy of attended automatic titration in a r and omized crossover study compared with manual titration over 2 nights where the sequence of the titration mode was changed . Therapy outcome was controlled after 6 weeks . Methods : 21 sleep apnea patients were treated using manual CPAP versus automatic APAP titration . The mode used during the 2nd night was continued for 6 weeks . Cardiorespiratory polysomnography , Epworth Sleepiness Scale ( ESS ) , SF-36 score and compliance were assessed . Results : Apnea-hypopnea index reduction was equally effective at similar effective pressure independent of the titration mode . If APAP was applied during the 1st night , total sleep time was longer ( 384 vs. 331 min , p < 0.01 ) and sleep efficacy was higher ( 91 vs. 81 % , p < 0.01 ) than after starting with manual titration with CPAP . Compliance was comparable in both groups ( 4.6 ± 1.9 h ) . The ESS improved in both groups ( from 12.9 to 6.5 ) . SF-36 scores and therapeutic pressure did not much change . Conclusions : Taking the sequence of titration into account , we found equal effectiveness of CPAP and APAP . Sleep quality was better with initial application of APAP – which favors attended automatic titration if only 1 titration night is possible . Both modes are comparable after 6 weeks regarding therapeutic pressure , efficacy , compliance and quality of life STUDY OBJECTIVE To determine whether fixed-pressure or variable-pressure CPAP was preferred by patients and gave better outcomes in patients with the obstructive sleep apnea/hypopnea syndrome ( OSAHS ) . DESIGN R and omized blinded cross-over trial with 6 weeks of fixed and 6 weeks of variable-pressure CPAP . SETTING Sleep center . PATIENTS 200 consecutive consenting CPAP naïve patients with daytime sleepiness and > 15 apneas + hypopneas/h after an attended auto-CPAP titration night . INTERVENTIONS CPAP therapy using the same device ( Autoset Spirit ) set for 6 weeks in fixed pressure mode and for 6 weeks in variable pressure mode , the order of therapies being r and omized . MEASUREMENTS AND RESULTS All measurements were recorded at the end of each limb by a research er blind to treatment . These included symptoms , Epworth Score , CPAP usage , objective sleepiness by modified Osler test , vigilance and health related quality of life .  A total of 181 of 200 patients completed the study . At the end of the study , patients expressed no significant difference in the primary outcome , patient preference , 72 patients preferring fixed and 69 preferring variable-pressure CPAP .  Epworth score was lower on variable ( 9.5 , SEM 0.4 ) than fixed-pressure CPAP ( 10.0 , SEM 0.3 ; P = 0.031 ) . Mean CPAP use was higher on variable ( 4.2 , SEM 0.2 h/night ) than fixed-pressure CPAP ( 4.0 , SEM 0.2 h/night ; P = 0.047 ) . There were no other significant differences between treatments . CONCLUSIONS This study shows no difference in patient preference and only a marginal benefit of variable over fixed-pressure CPAP in OSAHS in terms of subjective sleepiness and CPAP use . The clinical value of this difference remains to be determined . CLINICAL TRIAL INFORMATION Variable-pressure versus fixed-pressure continuous positive airway pressure ( CPAP ) treatment for patients with obstructive sleep apnoea/hypopnoea syndrome ( OSAHS ) ; Registration # IS RCT N43085025.http://www.controlled-trials.com//S RCT N43085025 STUDY OBJECTIVES To determine if auto-adjusting positive airway pressure ( APAP ) would be better tolerated on the basis of delivering a lower mean pressure in patients with mild to moderate obstructive sleep apnoea syndrome ( OSAS ) . DESIGN Patients spent 8 weeks on continuous positive airway pressure ( CPAP ) and 8 weeks on APAP in a r and omized crossover design . SETTING Respiratory Sleep Disorders Unit in a University Hospital and the patient 's home . PARTICIPANTS Twenty-nine patients with newly diagnosed mild to moderate OSAS ( apnoea-hypopnoea frequency of 5 - 30 events/hour ) were studied . INTERVENTIONS N/A. MEASUREMENTS AND RESULTS Overnight polysomnography and Epworth Sleepiness Scale were recorded at baseline and at the end of each treatment period in addition to patient preference for device , side effects , and objective compliance . No differences were found in polysomnographic variables or Epworth Sleepiness Scale scores between the 2 treatment modes , but all variables were significantly improved from baseline values . Mean APAP pressure levels were significantly lower than CPAP ( 6.3 + /- 1.4 vs 8.1 + /- 1.7 cm H2O , p < .001 ) . Patient compliance was similar with both treatments . More patients requiring higher fixed pressure ( > or = 8 cm H2O ) preferred APAP , whereas those requiring lower pressure ( < 8 cm H2O ) preferred CPAP ( p = .03 ) . Follow-up after 18 months of therapy indicated that 76 % of subjects continued to be compliant , with a nightly use of 5.8 + /- 1.9 hours per night , despite high levels of minor side effects . CONCLUSIONS APAP and CPAP are equally effective in managing patients with mild to moderate OSAS , but device preference may be influenced by fixed pressure requirements
Background Obstructive sleep apnea is a relatively common disorder that can lead to lost productivity and cardiovascular disease .
The form of positive airway treatment that should be offered is unclear .