Flexible positive airway pressure improves treatment adherence compared with auto-adjusting PAP.
OBJECTIVE
There are no clinical data comparing adherence and quality of life between auto-adjusting positive airway pressure (APAP) and two different flex positive airway pressure (PAP) devices (A-Flex, C-Flex) in patients with obstructive sleep apnea (OSA).


METHODS
Ninety-three patients in whom OSA was newly diagnosed were randomly assigned to receive 3 mo of APAP (n = 31), APAP with C-Flex (n = 31), or APAP with A-Flex (n = 31). Objective adherence was determined after 3 mo of CPAP treatment, and the Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), and Calgary Sleep Apnea Quality of Life Index (SAQLI) were examined at baseline and after 3 mo. After 3 mo, patients in the APAP with A-Flex group and those in the APAP with C-Flex group were crossed over and those in the APAP group were switched to A-Flex for an additional 3 mo.


RESULTS
The groups were similar demographically. Treatment adherence during the first 3 mo was significantly greater in the APAP with C-Flex group (APAP with C-Flex: 5.19 ± 1.84 h/night versus APAP: 3.96 ± 1.66 h/night versus APAP with A-Flex: 4.27 ± 2.12 h/night, P = 0.04). There was a significant improvement in two of four of the SAQLI domain scores and in the ESS and PSQI in the APAP with C-Flex group. Adherence significantly improved among the poor compliers (< 4 h/night of use) in the APAP group after change to APAP with A-Flex (P = 0.01).


CONCLUSIONS
Of these three modes of PAP delivery, adherence was greatest with APAP with C-Flex.


BACKGROUND
URL: http://www.clinicaltrials.gov. Unique identifier: NCT00873977.
Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.
Yuichi
Y
Chihara
Tomomasa
T
Tsuboi
Takefumi
T
Hitomi
Masanori
M
Azuma
Kimihiko
K
Murase
Yoshiro
Y
Toyama
Yuka
Y
Harada
Kensaku
K
Aihara
Kiminobu
K
Tanizawa
Tomohiro
T
Handa
Chikara
C
Yoshimura
Toru
T
Oga
Kazuhiko
K
Yamamoto
Michiaki
M
Mishima
Kazuo
K
Chin
D045422:Continuous Positive Airway Pressure / Q000295:instrumentation / Q000379:methods* / Q000523:psychology; D018592:Cross-Over Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D017286:Polysomnography; D016037:Single-Blind Method; D020181:Sleep Apnea, Obstructive / Q000523:psychology / Q000628:therapy*