Auto-adjusting versus fixed positive pressure therapy in mild to moderate obstructive sleep apnoea.
OBJECTIVE
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).


METHODS
Patients spent 8 weeks on continuous positive airway pressure (CPAP) and 8 weeks on APAP in a randomized crossover design.


METHODS
Respiratory Sleep Disorders Unit in a University Hospital and the patient's home.


METHODS
Twenty-nine patients with newly diagnosed mild to moderate OSAS (apnoea-hypopnoea frequency of 5-30 events/hour) were studied.


METHODS
N/A.


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 = 8cm 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.
Nolan
Geraldine M
GM
Respiratory Sleep Disorders Unit, St. Vincent's University Hospital, Dublin, Ireland.
Doherty
Liam S
LS
Mc Nicholas
Walter T
WT
D045422:Continuous Positive Airway Pressure / Q000295:instrumentation*; D018592:Cross-Over Studies; D006970:Disorders of Excessive Somnolence / Q000175:diagnosis / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017286:Polysomnography; D012648:Self Care; D012720:Severity of Illness Index; D012890:Sleep / Q000502:physiology; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*