title: A pilot study assessing adherence to auto-bilevel following a poor initial encounter with CPAP.
abstract: OBJECTIVE
  We hypothesized that early intervention with an auto bilevel device would improve treatment adherence compared to CPAP among OSA patients with a poor initial experience with lab-based CPAP titration.
  
  
  METHODS
  Patients with a poor initial CPAP experience were recruited for this parallel group, randomized, double-blind, controlled pilot study. After an in-lab titration, patients were randomized with either an auto-bilevel device or CPAP. Treatment adherence and functioning were assessed at 90 days.
  
  
  RESULTS
  We enrolled 51 subjects, with 47 completing the protocol. Groups were equally matched for gender, age, education, and OSA severity. There was no significant difference in the proportion of compliant subjects (≥ 4 h/night) between the auto bilevel and CPAP groups (62% vs. 54%; p = 0.624) after 90 days of use. Functional outcomes significantly improved in both groups during treatment use (p < 0.001) but did not differ between groups.
  
  
  CONCLUSIONS
  There was no statistically significant difference in adherence between the auto bilevel and CPAP groups in this study. Patients with a poor initial CPAP exposure may still achieve an acceptable long-term clinical outcome. Both groups demonstrated comparably significant improvements in functional outcomes, sleepiness, and fatigue complaints over the treatment period. CLINICAL TRIALS INFORMATION: NCT00635206 ClinicalTrials.gov
authors.affiliation: Sleep Therapy & Research Center, San Antonio, TX 78229, USA. powell.eric@sleeptrc.com
authors.forename: Eric D
authors.initials: ED
authors.lastname: Powell
authors.forename: Peter C
authors.initials: PC
authors.lastname: Gay
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Ojile
authors.forename: Mikhail
authors.initials: M
authors.lastname: Litinski
authors.forename: Atul
authors.initials: A
authors.lastname: Malhotra
mesh_terms: D045422:Continuous Positive Airway Pressure / Q000295:instrumentation* / Q000379:methods; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D010865:Pilot Projects; D017286:Polysomnography; D020181:Sleep Apnea, Obstructive / Q000523:psychology / Q000628:therapy*; D016896:Treatment Outcome