title: Auto-adjusting positive airway pressure treatment for sleep apnea diagnosed by home sleep testing.
abstract: OBJECTIVE
  Compare auto-adjusting positive airway pressure (APAP) treatment with positive airway pressure (PAP) titration by polysomnography (PSG) followed by CPAP treatment in patients diagnosed with obstructive sleep apnea (OSA) by home sleep apnea testing (HSAT).
  
  
  METHODS
  Prospective randomized treatment study.
  
  
  METHODS
  Tertiary Veterans Administration Medical Center.
  
  
  METHODS
  156 patients diagnosed with OSA by HSAT (apneahypopnea index [AHI] ≥ 10/h) suitable for APAP treatment.
  
  
  METHODS
  APAP arm: Treatment with an APAP device, CPAP arm: PSG PAP titration followed by CPAP treatment.
  
  
  METHODS
  Mean PAP adherence, Epworth sleepiness scale (ESS), Functional Outcomes of Sleep Questionnaire (FOSQ).
  
  
  RESULTS
  The mean (± SD) age, BMI, and diagnostic AHI (APAP: 28.6 ± 18.5, CPAP: 28.3 ± 16.0/h, p = NS) did not differ between the study arms. After 6 weeks of treatment, 84.6% of 78 patients started on APAP and 84.3% of 70 patients started on CPAP (8 declined treatment after the titration) were using PAP, p = NS. The 90% APAP and level of CPAP were similar (10.8 ± 3.1, 11.7 ± 2.5 cm H2O, p = 0.07). The average nightly PAP use did not differ (APAP: 4.45 ± 2.3, CPAP: 4.0 ± 2.3 h, p = NS). The improvements in the ESS (APAP: -4.2 ± 4.7, CPAP: -3.7 ± 4.8, p = NS) and in the FOSQ (APAP: 2.6 ± 3.5, CPAP: 2.2 ± 3.7, p = NS) were not different.
  
  
  CONCLUSIONS
  Following diagnosis of OSA by HSAT, treatment with APAP results in equivalent PAP adherence and improvement in sleepiness compared to a PSG titration and CPAP treatment.
  
  
  CONCLUSIONS
  A commentary on this article appears in this issue on page 1277.
authors.affiliation: Malcom Randall VA Medical Center, University of Florida, Gainesville, FL.
authors.forename: Richard B
authors.initials: RB
authors.lastname: Berry
authors.affiliation: Malcom Randall VA Medical Center, University of Florida, Gainesville, FL.
authors.forename: Peruvemba
authors.initials: P
authors.lastname: Sriram
mesh_terms: D045422:Continuous Positive Airway Pressure / Q000379:methods*; D005260:Female; D006699:Home Care Services; D006801:Humans; D008297:Male; D008875:Middle Aged; D017286:Polysomnography / Q000379:methods*; D011446:Prospective Studies; D012891:Sleep Apnea Syndromes / Q000628:therapy*; D011795:Surveys and Questionnaires
keywords: auto-adjusting positive airway pressure; home sleep testing; obstructive sleep apnea