Importance of sleep stage- and body position-dependence of sleep apnoea in determining benefits to auto-CPAP therapy.
The influence of sleep stage- and body position-dependence of sleep apnoea on treatment efficacy and compliance between conventional continuous positive airway pressure (CPAP) and auto CPAP therapy was evaluated. Thirty-three newly treated sleep apnoea hypopnoea syndrome (SAHS) patients were randomly allocated to conventional or auto-CPAP therapy. Six patients of each treatment group were classified as having sleep stage- and body position-dependent obstructive breathing abnormalities according to the results of the baseline sleep study. After 3 weeks of treatment, the Epworth sleepiness score tended to be higher (p = 0.08) and the ability to stay awake lower (p = 0.02) in patients with dependent breathing abnormalities treated with fixed CPAP, than in the other patients. The effective pressure/time index was significantly lower in sleep stage- and body position-dependent patients treated with fixed CPAP, than in the other patients (p = 0.02). The number of hours the machine was turned on and a positive pressure applied, tended to be smaller in dependent patients treated with fixed CPAP than in independent patients of this treatment group and in patients treated with auto-CPAP. A night-to-night variability index (VI) of positive pressure changes was obtained in the auto-CPAP group. This index significantly decreased with time in the dependent patients while it remained unchanged in the independent group. It is concluded that auto-continuous positive airway pressure may have specific indications in a subset of obstructive sleep apnoea patients with sleep stage- and body position dependent nocturnal breathing abnormalities.
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Unité De Recherche Centre de pneumologie, Hôpital Laval, Université Laval, Québec, Canada.
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D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011175:Positive-Pressure Respiration / Q000379:methods*; D011187:Posture / Q000502:physiology*; D020181:Sleep Apnea, Obstructive / Q000503:physiopathology / Q000628:therapy*; D012894:Sleep Stages / Q000502:physiology*; D016896:Treatment Outcome