title: Auto-titrating versus fixed continuous positive airway pressure for the treatment of obstructive sleep apnea: a systematic review with meta-analyses.
abstract: BACKGROUND
  Obstructive sleep apnea is a relatively common disorder that can lead to lost productivity and cardiovascular disease. The form of positive airway treatment that should be offered is unclear.
  
  
  METHODS
  MEDLINE and the Cochrane Central Trials registry were searched for English language randomized controlled trials comparing auto-titrating positive airway pressure (APAP) with continuous positive airway pressure (CPAP) in adults with obstructive sleep apnea (inception through 9/2010). Six researchers extracted information on study design, potential bias, patient characteristics, interventions and outcomes. Data for each study were extracted by one reviewer and confirmed by another. Random effects model meta-analyses were performed for selected outcomes.
  
  
  RESULTS
  Twenty-four randomized controlled trials met the inclusion criteria. In individual studies, APAP and fixed CPAP resulted in similar changes from baseline in the apnea-hypopnea index, most other sleep study measures and quality of life. By meta-analysis, APAP improved compliance by 11 minutes per night (95% CI, 3 to 19 minutes) and reduced sleepiness as measured by the Epworth Sleepiness Scale by 0.5 points (95% CI, 0.8 to 0.2 point reduction) compared with fixed CPAP. Fixed CPAP improved minimum oxygen saturation by 1.3% more than APAP (95% CI, 0.4 to 2.2%). Studies had relatively short follow-up and generally excluded patients with significant comorbidities. No study reported on objective clinical outcomes.
  
  
  CONCLUSIONS
  Statistically significant differences were found but clinical importance is unclear. Because the treatment effects are similar between APAP and CPAP, the therapy of choice may depend on other factors such as patient preference, specific reasons for non-compliance and cost.
authors.affiliation: Institute of Clinical Research and Health Policy Studies, Tufts University School of Medicine, Tufts Medical Center, Boston, MA, USA.
authors.forename: Stanley
authors.initials: S
authors.lastname: Ip
authors.forename: Carolyn
authors.initials: C
authors.lastname: D'Ambrosio
authors.forename: Kamal
authors.initials: K
authors.lastname: Patel
authors.forename: Ndidiamaka
authors.initials: N
authors.lastname: Obadan
authors.forename: Georgios D
authors.initials: GD
authors.lastname: Kitsios
authors.forename: Mei
authors.initials: M
authors.lastname: Chung
authors.forename: Ethan M
authors.initials: EM
authors.lastname: Balk
mesh_terms: D000328:Adult; D045422:Continuous Positive Airway Pressure; D006801:Humans; D011175:Positive-Pressure Respiration / Q000379:methods*; D016032:Randomized Controlled Trials as Topic; D020181:Sleep Apnea, Obstructive / Q000628:therapy*