Two months auto-adjusting versus conventional nCPAP for obstructive sleep apnoea syndrome.
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 randomly 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.
Teschler
H
H
Dept. of Pneumology/Sleep Medicine, Ruhrlandklinik, Medical Faculty, University of Essen, Germany.
Wessendorf
T E
TE
Farhat
A A
AA
Konietzko
N
N
Berthon-Jones
M
M
D000328:Adult; D000368:Aged; D018592:Cross-Over Studies; D004311:Double-Blind Method; D006701:Home Nursing; D006801:Humans; D000860:Hypoxia / Q000628:therapy; D008170:Lung Compliance; D008297:Male; D008397:Masks; D008875:Middle Aged; D009666:Nose; D017286:Polysomnography; D011175:Positive-Pressure Respiration / Q000295:instrumentation* / Q000379:methods*; D020181:Sleep Apnea, Obstructive / Q000628:therapy*