Automatic pressure titration with APAP is as effective as manual titration with CPAP in patients with obstructive sleep apnea.
BACKGROUND
The optimal approach to initiate positive-pressure therapy in patients with obstructive sleep apnea is still debated. Current options are autotitrating positive airway pressure (APAP) or manual titration with continuous positive airway pressure (CPAP). Procedures differ by parameters and by algorithms used for adapting pressure.


OBJECTIVE
To evaluate the efficacy of attended automatic titration in a randomized crossover study compared with manual titration over 2 nights where the sequence of the titration mode was changed. Therapy outcome was controlled after 6 weeks.


METHODS
21 sleep apnea patients were treated using manual CPAP versus automatic APAP titration. The mode used during the 2nd night was continued for 6 weeks. Cardiorespiratory polysomnography, Epworth Sleepiness Scale (ESS), SF-36 score and compliance were assessed.


RESULTS
Apnea-hypopnea index reduction was equally effective at similar effective pressure independent of the titration mode. If APAP was applied during the 1st night, total sleep time was longer (384 vs. 331 min, p < 0.01) and sleep efficacy was higher (91 vs. 81%, p < 0.01) than after starting with manual titration with CPAP. Compliance was comparable in both groups (4.6 +/- 1.9 h). The ESS improved in both groups (from 12.9 to 6.5). SF-36 scores and therapeutic pressure did not much change.


CONCLUSIONS
Taking the sequence of titration into account, we found equal effectiveness of CPAP and APAP. Sleep quality was better with initial application of APAP - which favors attended automatic titration if only 1 titration night is possible. Both modes are comparable after 6 weeks regarding therapeutic pressure, efficacy, compliance and quality of life.
Fietze
Ingo
I
Center of Sleep Medicine, Charité-Universitatsmedizin Berlin, Berlin, Germany. ingo.fietze@charite.de
Glos
Martin
M
Moebus
Isabel
I
Witt
Christian
C
Penzel
Thomas
T
Baumann
Gert
G
D000328:Adult; D018592:Cross-Over Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D017286:Polysomnography / Q000379:methods; D011175:Positive-Pressure Respiration / Q000295:instrumentation / Q000379:methods*; D020181:Sleep Apnea, Obstructive / Q000628:therapy*; D012894:Sleep Stages / Q000502:physiology; D016896:Treatment Outcome