The current status of autotitrating continuous positive airway pressure systems in the management of obstructive sleep apnea.
BACKGROUND
Autotitrating continuous positive airway pressure (APAP) devices have the potential to address some of the disadvantages of titration and treatment with conventional continuous positive airway pressure (CPAP). Information on the performance of APAP in clinical use is still comparatively limited.


OBJECTIVE
To assess the status of APAP devices in the management of obstructive sleep apnea (OSA) by reviewing evidence of their efficacy, effectiveness and costs.


METHODS
A systematic search of electronic databases and a review of selected comparative studies on the use of APAP in the diagnosis, titration and treatment of OSA was undertaken. Cost analysis using data applicable to the management of OSA in Edmonton, Alberta was performed.


RESULTS
Thirty-three studies met the selection criteria: three on the use of APAP in diagnosing OSA; six on APAP for titration; 14 that considered short-term treatment outcomes; and 10 that addressed longer-term treatment of OSA. In most studies, patients suffering from cardiac, pulmonary and other medical conditions were excluded. Available data suggested some potential for the use of APAP in the diagnosis of OSA, but further validation is needed. In titration, estimated treatment pressures tended to be lower with APAP than with the manual titration of CPAP. Although lower treatment pressures were achieved with APAP, there was no significant difference in clinical outcome measures between APAP and CPAP. Estimates of costs suggested that APAP may provide savings in some scenarios.


CONCLUSIONS
APAP shows promise in the management of OSA; however, given the exclusion of some categories of patients from trials of this technology, caution is still required in its use.
Hailey
David
D
Department of Public Health Sciences, University of Alberta, Edmonton, Alberta, Canada. dhailey@ozemail.com.au
Jacobs
Philip
P
Mayers
Irvin
I
Mensinkai
Shaila
S
D045422:Continuous Positive Airway Pressure / Q000295:instrumentation*; D003365:Costs and Cost Analysis; D006801:Humans; D020181:Sleep Apnea, Obstructive / Q000191:economics / Q000628:therapy*