Auto-Adjusting Versus Fixed Positive Pressure Therapy in Mild to Moderate Obstructive Sleep Apnoea

Nolan, Geraldine; Doherty, Liam S.; Nicholas, Walter T. Mc

doi:10.1093/sleep/30.2.189

Cited by 46 publications

(39 citation statements)

References 26 publications

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“…However, the present study design was specifically chosen to directly compare these three APAP devices, an objective that would have been more difficult in treatment-naive patients. There are only limited data on APAP therapy in patients with mild OSAS, although a preliminary report from the current authors' Respiratory Sleep Disorders Unit indicates no consistent preference for APAP over CPAP therapy in patients with mild disease [27].…”

Section: Discussionmentioning

confidence: 65%

Comparison of three auto-adjusting positive pressure devices in patients with sleep apnoea

Nolan

Ryan²,

O'Connor³

et al. 2006

European Respiratory Journal

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Auto-adjustable continuous positive airway pressure (APAP) devices are an emerging treatment alternative to fixed-pressure continuous positive airway pressure (CPAP) therapy for obstructive sleep apnoea syndrome. They have been engineered to automatically adjust the pressure to the optimal level on a continuous basis. However, not all APAP technologies use the same algorithm. Three different APAP devices (Autoset Spirit, Breas PV 10i and RemStar Auto) were compared in a randomised crossover trial in patients already established on fixed-pressure CPAP therapy. The outcome measures were compliance, quality of life and side-effects.Twenty-seven middle-aged patients (25 male) previously diagnosed with severe obstructive sleep apnoea syndrome (median (interquartile range) apnoea/hypopnoea index 48 (29-76)), established on CPAP therapy for .3 yrs, were randomised to each APAP device for 4 weeks.Mean pressure and patient compliance were significantly lower on the Breas PV 10i than on the other APAP devices. The devices were similar in terms of quality of life, daytime sleepiness and upper airway side-effects, but patients evaluated them significantly differently in terms of device features, sleep quality and pressure comfort, with the Breas PV 10i being the least popular.Auto-adjustable positive airway pressure devices differ in pressure delivery and patient compliance in obstructive sleep apnoea syndrome patients.

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Section: Discussionmentioning

confidence: 65%

Comparison of three auto-adjusting positive pressure devices in patients with sleep apnoea

Nolan

Ryan²,

O'Connor³

et al. 2006

European Respiratory Journal

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“…Generally the device defines normal airflow for the patient, and delivers additional pressure when the flow curve is restricted. 15 APAP devices may be useful for patients whose titration-recommended setting was not suitable due to the inherent limited sampling of a single night or half-night titration study. 11,15 APAP therapy may also be considered for patients in whom large weight fluctuations 11 are anticipated, such as pregnant patients or those undergoing bariatric surgery.…”

Section: What If My Osa Patients Have Trouble Tolerating the Cpap Setmentioning

confidence: 99%

“…15 APAP devices may be useful for patients whose titration-recommended setting was not suitable due to the inherent limited sampling of a single night or half-night titration study. 11,15 APAP therapy may also be considered for patients in whom large weight fluctuations 11 are anticipated, such as pregnant patients or those undergoing bariatric surgery. Contraindications to APAP include congestive heart failure, lung disease such as chronic obstructive pulmonary disease, obesity hypoventilation syndrome, lack of snoring, or central sleep apnea.…”

Section: What If My Osa Patients Have Trouble Tolerating the Cpap Setmentioning

confidence: 99%

Treatment options for obstructive sleep apnea

Pavwoski

Shelgikar

2017

Neur Clin Pract

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Purpose of review:Obstructive sleep apnea (OSA) is a global problem with implications for general health and quality of life, and is often encountered in patients with neurologic disease. This review outlines treatment modalities to consider for management of OSA in patients with neurologic disease.Recent findings:New advances in positive airway pressure (PAP) devices, oral appliances, and surgical interventions offer a wide range of treatment options for patients with OSA.Summary:PAP therapy remains the gold standard treatment for OSA. Other treatment modalities may be considered for OSA patients who decline or cannot tolerate PAP therapy. Some OSA patients may benefit from multimodal treatment.

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“…Use of auto-titrating positive airway pressure (APAP) devices can also streamline management of OSA by obviating the need to perform attended PSG PAP titration in some OSA patients [11]. Studies have shown equivalent outcomes using APAP compared to manual PAP titration in appropriately selected patients; medically stable patients at high risk for moderate to severe OSA who do not have significant cardiorespiratory comorbidities [12][13][14][15][16]. Combining HSAT and APAP, it is possible to construct a home-based OSA management strategy as an alternative to lab-based PSG and titration.…”

Section: Introductionmentioning

confidence: 99%

Home- vs. Laboratory-Based Management Of OSA: An Economic Review

Kim

Kapur

2016

Curr Sleep Medicine Rep

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Obstructive sleep apnea (OSA) is a common condition that impairs quality of life and health. Diagnosis and treatment of OSA is cost-effective; however, the economics of various management strategies remain to be defined. Home sleep apnea tests (HSAT) provide an alternative to laboratory based polysomnography (PSG) and are less expensive than PSG on a per test basis; however, when utilized within a framework that has been demonstrated to provide comparable clinical outcomes, home testing pathways incur additional costs to compensate for failed studies and lower diagnostic accuracy. A cost-minimization analysis from a randomized controlled trial showed that the cost advantage of a home management pathway narrowed significantly when these additional costs are considered. Further, when the actual costs of providing HSAT rather than what is reimbursed by insurance were considered, the cost advantage was further attenuated. A comprehensive cost-effectiveness analysis (CEA), favored a lab over a home approach based on modeling that projected that the costs of erroneous diagnosis over a long time span for the home approach outweighed lower test costs. Studies have identified the following factors that influence costeffectiveness of home-based management: cost of untreated OSA, prevalence of OSA, performance characteristics of the selected test, time horizon, and whether backup PSG is used for failed HSAT. More clinical studies are needed to provide the inputs for more robust CEA regarding this issue.

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Auto-Adjusting Versus Fixed Positive Pressure Therapy in Mild to Moderate Obstructive Sleep Apnoea

Abstract: APAP and CPAP are equally effective in managing patients with mild to moderate OSAS, but device preference may be influenced by fixed pressure requirements.

Cited by 46 publications

References 26 publications

Comparison of three auto-adjusting positive pressure devices in patients with sleep apnoea

Comparison of three auto-adjusting positive pressure devices in patients with sleep apnoea

Treatment options for obstructive sleep apnea

Home- vs. Laboratory-Based Management Of OSA: An Economic Review

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