title: Auto-titrating versus standard continuous positive airway pressure for the treatment of obstructive sleep apnea: results of a meta-analysis.
abstract: OBJECTIVE
  To compare the effectiveness of auto-titrating continuous positive airway pressure (APAP) versus conventional continuous positive airway pressure (CPAP) in reducing the apnea-hypopnea index (AHI), reducing the mean airway pressure, improving subjective sleepiness, and improving treatment adherence in patients with obstructive sleep apnea (OSA).
  
  
  METHODS
  Meta-analysis and metaregression of published randomized trials comparing APAP to CPAP.
  
  
  METHODS
  N/A.
  
  
  METHODS
  N/A.
  
  
  METHODS
  N/A.
  
  
  RESULTS
  We identified 9 randomized trials studying a total of 282 patients. Compared to CPAP, there was no significant advantage of APAP in reducing AHI or sleepiness (pooled APAP-CPAP posttreatment AHI and Epworth Sleepiness Scale score = -0.20 events per hour, 95% confidence interval:[-0.74,0.35], and -0.56 [-1.4,0.3] respectively). The use of APAP reduced the mean applied pressure across the night by 2.2 cm water [1.9,2.5] compared to CPAP. Adherence with therapy was not substantially improved with APAP; pooled estimate of improvement was 0.20 hours per night ([-0.16,0.57], P = .28) using a random-effects model.
  
  
  CONCLUSIONS
  Compared to standard CPAP, APAP is associated with a reduction in mean pressure. However, APAP and standard CPAP were similar in adherence and their ability to eliminate respiratory events and to improve subjective sleepiness. Given that APAP is more costly than standard CPAP, APAP should not be considered first-line chronic therapy in all patients with OSA. However, APAP may be useful in other situations (eg, home titrations, detection of mouth leak) or in certain subgroups of patients with OSA. Identifying circumstances in which APAP is a definite improvement over CPAP in terms of costs or effects should be the focus of future studies.
authors.affiliation: Department of Medicine, University of British Colombia. ayasnajib@pol.net
authors.forename: Najib T
authors.initials: NT
authors.lastname: Ayas
authors.forename: Sanjay R
authors.initials: SR
authors.lastname: Patel
authors.forename: Atul
authors.initials: A
authors.lastname: Malhotra
authors.forename: Michael
authors.initials: M
authors.lastname: Schulzer
authors.forename: Mark
authors.initials: M
authors.lastname: Malhotra
authors.forename: David
authors.initials: D
authors.lastname: Jung
authors.forename: John
authors.initials: J
authors.lastname: Fleetham
authors.forename: David P
authors.initials: DP
authors.lastname: White
mesh_terms: D006801:Humans; D011175:Positive-Pressure Respiration / Q000145:classification* / Q000379:methods*; D016032:Randomized Controlled Trials as Topic; D020181:Sleep Apnea, Obstructive / Q000628:therapy*