Transition from APAP to CPAP may be a cost-effective health intervention in OSA patients

Alves, Adelaide; Gigante, Ana Rita; Machado, Daniela; Sanches, Inês; Marçôa, Raquel; Franco, Inês; Nogueira, Carla; Ferreira, Daniela

doi:10.36416/1806-3756/e20210286

Cited by 3 publications

(6 citation statements)

References 28 publications

(57 reference statements)

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“…The findings of the study by Alves et al 11 corroborate what we witness in daily practice, i.e., that most patients with OSA tolerate CPAP and APAP equally, with CPAP being better tolerated than APAP in some cases. Thus, CPAP may be the preferable option for a significant subset of patients.…”

supporting

confidence: 84%

“…In the current issue of the Jornal Brasileiro de Pneumologia , Alves et al 11 present an interesting study carried out at a sleep medicine center in Portugal and evaluating the effectiveness and potential savings generated by the use of a protocol aimed at switching previously treated OSA patients from APAP to CPAP. They prospectively included 93 OSA patients who were well adapted to APAP therapy (i.e., who were adherent to treatment, had a normal AHI, and had no relevant air leak) to switch to fixed-pressure CPAP based on the 90-95th percentile of pressures recorded by the APAP device in the previous months.…”

mentioning

confidence: 99%

“…According to the authors, 11 the study has some limitations, including a possible selection bias, given that only patients who were well adapted and adherent to treatment with APAP were selected for CPAP therapy. Moreover, the fact that the study was carried out in only one center in Portugal can limit the external validity of the findings.…”

mentioning

confidence: 99%

“…The study by Alves et al 11 suggests that APAP should be used primarily as an initial therapeutic strategy for pressure titration. After a few days, switching to CPAP is as effective but cheaper.…”

mentioning

confidence: 99%

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Less may be more: CPAP vs. APAP in the treatment of obstructive sleep apnea

Perin

Genta

2021

J Bras Pneumol.

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supporting

confidence: 84%

mentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Less may be more: CPAP vs. APAP in the treatment of obstructive sleep apnea

Perin

Genta

2021

J Bras Pneumol.

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“…Alves et al showed that transition from APAP to CPAP therapy may be an effective, cost-saving strategy in patients with OSA (Alves et al, 2021). If long-term fixed CPAP therapy is aimed for, hometitration with a fixed CPAP device omits the need to change the device after the APAP titration period simplifying the logistics of a sleep clinic.…”

Section: Fietze Et Al Compared In a Rct In-hospital Apap Titration Ver-mentioning

confidence: 99%

Telemonitoring‐guided ambulatory fixed CPAP titration versus ambulatory APAP titration in moderate obstructive sleep apnea: A non‐inferiority randomized controlled trial

Testelmans

Papadopoulos

Kalkanis

et al. 2023

Journal of Sleep Research

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SummaryThe present study aimed to evaluate whether titration of fixed continuous positive airway pressure at home using telemonitoring produces patient outcomes equal to auto‐adjusting positive airway pressure titration at home for patients with moderate obstructive sleep apnea. Patients were randomized with a 1:1 allocation ratio to receive either auto‐adjusting positive airway pressure titration based on the median of the 95th percentile pressure across seven nights or fixed continuous positive airway pressure titration based on a fixed calculated pressure and specific adaptations after telemonitoring of device data after 3 and 7 nights. The results of the ambulatory titration were evaluated with in‐laboratory polysomnography after 2 weeks. We hypothesized that fixed continuous positive airway pressure titration would be non‐inferior to auto‐adjusting positive airway pressure titration in respect to continuous positive airway pressure adherence at a 3‐month follow‐up. A non‐inferiority margin of −0.75 hr was prespecified. One‐hundred and four patients were randomly allocated to fixed continuous positive airway pressure (n = 52) and auto‐adjusting positive airway pressure (n = 52) titration. The mean difference and the 95% confidence intervals in continuous positive airway pressure adherence after 3 months between the two arms were 0.80 (−0.08, 1.69) hr. The non‐inferiority hypothesis was confirmed as the lower one‐sided 97.5% confidence interval for the mean difference was above the prespecified margin. Patients in the fixed continuous positive airway pressure titration arm were titrated at significantly lower pressure level and had a significantly lower amount of average leaks compared with auto‐adjusting positive airway pressure‐titrated patients, while there was no difference in residual obstructive apnea–hypopnea index on polysomnography. Telemonitoring enables ambulatory continuous positive airway pressure titration with fixed pressure that is non‐inferior to ambulatory titration with auto‐adjusting pressure in patients with moderate obstructive sleep apnea.

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Treatment of obstructive sleep apnea with a simple CPAP device

Qiu

Liang

Deng³

et al. 2023

Sleep Breath

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Purpose CPAP is the “gold standard” treatment for obstructive sleep apnea (OSA). Current CPAP models have developed additional functions including automatic CPAP and pressure relief. However, CPAP adherence has not improved over the last three decades. Many patients in low-income countries cannot afford these CPAP devices. A novel simple CPAP device with a fixed pressure without pressure controller was developed. Methods Manual CPAP pressure titration was performed in 127 patients with OSA. Six patients with a titration pressure higher than 11 cmH2O and 14 patients who could not tolerate CPAP were excluded, leaving 107 participating in the following 2 studies. In study one, 54 of 107 patients were treated by both conventional fixed CPAP and simple CPAP in random order. In the second study, another 53 patients were treated by both autoCPAP in automatic function and simple CPAP in random order. Simple CPAP was fixed at 10 cmH2O, 8 cmH2O, and 6 cmH2O for patients whose titration pressure was between 9–10, 7–8, and ≤ 6 cmH2O, respectively. Conventional fixed CPAP device was set exactly the same as manual titration pressure. Results All patients whose manual titration pressure ≤ 10 cmH2O were effectively treated by simple CPAP (AHI 40.7 ± 2.3 events/h before vs 2.5 ± 0.3 events/h after, p < 0.001). Patients expressed similar preferences for simple CPAP, autoCPAP, and conventional fixed CPAP (p > 0.05). Conclusions We conclude that a novel simple CPAP is an alternative treatment for most patients with OSA, which may widen access to CPAP therapy in the developing countries because of its low cost.

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Transition from APAP to CPAP may be a cost-effective health intervention in OSA patients

Cited by 3 publications

References 28 publications

Less may be more: CPAP vs. APAP in the treatment of obstructive sleep apnea

Less may be more: CPAP vs. APAP in the treatment of obstructive sleep apnea

Telemonitoring‐guided ambulatory fixed CPAP titration versus ambulatory APAP titration in moderate obstructive sleep apnea: A non‐inferiority randomized controlled trial

Treatment of obstructive sleep apnea with a simple CPAP device

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