Background: Long-term compliance is suboptimal in the treatment of the obstructive sleep apnea syndrome (OSAS). Objectives: We compared the efficacy of and the adherence to automatic continuous positive airway pressure (APAP) and constant continuous positive airway pressure (CPAP) based on a night-by-night analysis. Methods: We performed a randomized, single-blind crossover study in 20 patients with moderate-to-severe OSAS. After diagnostic polysomnography and manual titration, patients were treated for 8 weeks with both constant CPAP and APAP in random order. Compliance and leakage were analyzed night by night using the software LOGSoft® of the Magellan® i PAP device. Results: The reduction in the apnea/hypopnea index (baseline 32.9 ± 19.1/h, CPAP 4.6 ± 2.9/h, APAP 5.6 ± 3.6/h; p < 0.001 compared to baseline) and the Epworth Sleepiness Scale (baseline 10.3 ± 5.7, CPAP 6.6 ± 4.8, APAP 4.9 ± 4.6; p < 0.001 compared to baseline) did not significantly differ between the treatment modes. Leakage time and compliance per night were not statistically different (leakage CPAP 31 ± 57 min, APAP 25 ± 49 min; compliance CPAP 383 ± 116 min, APAP 382 ± 107 min). There was no correlation between leakage and compliance. Thirteen patients (65%) preferred APAP at the end of the study. Conclusions: Treatment efficacy and adherence are similar with CPAP and APAP. There is a trend towards lower leakage with APAP therapy. Patients prefer the automatic mode to fixed pressure.

Keywords:
Automatic continuous positive airway pressure, Compliance, Continuous positive airway pressure, Night-by-night analysis, Obstructive sleep apnea
1.
Remmer JE, deGroot WJ, Sauerland EK, et al: Pathogenesis of upper airway occlusion during sleep. J Appl Physiol 1978;44:931–938.
2.
Partinen M, Guilleminault: Daytime sleepiness and vascular morbidity at seven-year follow-up in obstructive sleep apnea patients. Chest 1990;97:27–32.
3.
Kales A, Caldwell AB, Cadieux RJ, et al: Severe obstructive sleep apnea. II. Associated psychopathology and psychosocial consequences. J Chronic Dis 1985;38:427–434.
4.
Barbé F, Pericás J, Munoz A, et al: Automobile accidents in patients with sleep apnea syndrome. Am J Respir Crit Care Med 1998;158:18–22.
5.
Doherty LS, Kiely JL, Swan V, et al: Long-term effects of nasal continuous positive airway pressure therapy on cardiovascular outcomes in sleep apnea syndrome. Chest 2005;127:2076–2084.
6.
Loube DI, Gay PC, Strohl KP, et al: Indications for positive airway pressure treatment for adult obstructive sleep apnea patients: a consensus statement. Chest 1999;115:863–866.
7.
McArdle N, Devereux G, Heidarnejad H, et al: Long-term use of CPAP therapy for sleep apnea/hypopnea syndrome. Am J Respir Crit Care Med 1999;159:1108–1114.
8.
Randerath WJ, Parys K, Feldmeyer F, et al: Self-adjusting nasal continuous positive airway pressure therapy based on the measurement of impedance: a comparison of two different maximum pressure levels. Chest 1999;116:991–999.
9.
d’Ortho PM, Grillier-Lanoir V, Levy P, et al: Constant vs. automatic continuous positive airway pressure therapy: home evaluation. Chest 2000;118:1010–1017.
10.
Randerath WJ, Galetke W, David M, et al: Prospective randomized comparison of impedance-controlled auto-continuous positive airway pressure (APAP(FOT)) with constant CPAP. Sleep Med 2001;2:115–124.
11.
Sharma S, Wali S, Pouliot Z, et al: Treatment of obstructive sleep apnea with a self-titrating continuous positive airway pressure (CPAP) system. Sleep 1996;19:497–501.
12.
Teschler H, Berthon-Jones M, Thompson AB, et al: Automated continuous positive airway pressure titration for obstructive sleep apnea syndrome. Am J Respir Crit Care Med 1996;154:734–740.
13.
Randerath WJ, Schraeder O, Galetke W, et al: Auto-adjusting CPAP therapy based on impedance. Efficacy, compliance and acceptance. Am J Respir Crit Care Med 2001;163:652–657.
14.
Konermann M, Sanner BM, Vyleta M, et al: Use of conventional and self-adjusting nasal continuous positive airway pressure for treatment of severe obstructive sleep apnea syndrome: a comparative study. Chest 1998;113:714-718.
15.
Rechtschaffen A, Kales A: A Manual of Standardized Terminology Techniques and Scoring System for Sleep Stages of Human Subjects. Brain Information Service. Los Angeles, University of California, 1968.
16.
ASDA Task Force: EEG arousals: scoring rules and examples. Sleep 1992;15:173–184.
17.
Behbehani K, Yen F, Lucas EA, et al: A sleep laboratory evaluation of an automatic positive airway pressure system for treatment of obstructive sleep apnea. Sleep 1998;21:485–491.
18.
Lofaso F, Lorino AM, Duizabo D, et al: Evaluation of an auto-CPAP device based on snoring detection. Eur Respir J 1996;9:1795–1800.
19.
Meurice JC, Marc I, Series F: Efficacy of auto-CPAP in the treatment of obstructive sleep apnea/hypopnea syndrome. Am J Respir Crit Care Med 1996;153:794–798.
20.
Boudewyns A, Grillier-Lanoir V, Willemen MJ, et al: Two months follow up of auto-CPAP treatment in patients with obstructive sleep apnoea. Thorax 1999;54:147–149.
21.
Scharf MB, Brannen DE, McDannold MD, et al: Computerized adjustable versus fixed NCPAP treatment of obstructive sleep apnea. Sleep 1996;19:491–496.
22.
Teschler H, Wessendorf TE, Farhat AA, et al: Two months auto-adjusting versus conventional nCPAP for obstructive sleep apnoea syndrome. Eur Respir J 2000;15:990–995.
23.
Ficker JH, Wiest GH, Lehnert G, et al: An auto-continuous positive airway pressure device controlled exclusively by the forced oscillation technique. Eur Respir J 2000;16:914–920.
24.
Series F, Marc I: Efficacy of automatic continuous positive airway pressure therapy that uses an estimated required pressure in the treatment of the obstructive sleep apnea syndrome. Ann Intern Med 1997;127:588–595.
25.
Hudgel DW, Fung C: A long-term randomized cross-over comparison of auto-titrating and standard nasal continuous positive airway pressure. Sleep 2000;23:1–4.
26.
Massie CA, McArdle N, Hart RW, et al: Comparison between automatic and fixed positive airway pressure therapy in the home. Am J Respir Crit Care Med 2003;167:20–23.
27.
Ayas NT, Patel SR, Malhotra A, et al: Auto-titrating versus standard continuous positive airway pressure for the treatment of obstructive sleep apnea: results of a meta-analysis. Sleep 2004;27:249–253.
28.
Engleman HM, Martin SE, Douglas NJ: Compliance with CPAP therapy in patients with the sleep apnoea/hypopnoea syndrome. Thorax 1994;49:263–266.
29.
Pepin JL, Leger P, Veale D, et al: Side effects of nasal continuous positive airway pressure in sleep apnea syndrome. Study of 193 patients in two French sleep centers. Chest 1995;107:375–381.
30.
Hukins C: Comparative study of autotitrating and fixed-pressure CPAP in the home: a randomised, single-blind crossover trial. Sleep 2004;27:1512–1517.
31.
Sin DD, Mayers I, Man GC, et al: Long-term compliance rates to continuous positive airway pressure in obstructive sleep apnea. Chest 2002;121:430–435.
32.
De Koninck J, Lorrain D, Gagnon P: Sleep positions and position shifts in five age groups: an ontogenetic picture. Sleep 1992;15:143–149.
33.
Marrone O, Resta O, Salvaggio A, et al: Preference for fixed or automatic CPAP in patients with obstructive sleep apnea syndrome. Sleep Med 2004;5:247–251.
© 2007 S. Karger AG, Basel
2006
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