Comparison between Automatic and Fixed Positive Airway Pressure Therapy in the Home

Massie, Clifford A.; McArdle, Nigel; Hart, R. W.; Schmidt-Nowara, Wolfgang; Lankford, Alan; Hudgel, David W.; Gordon, Nancy; Douglas, Neil J.

doi:10.1164/rccm.200201-022oc

Cited by 159 publications

(102 citation statements)

References 36 publications

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“…In this group of patients, sleepiness scores were better on APAP than on CPAP. In a trial of patients requiring higher pressures, APAP resulted in a greater than 30 min per night improvement in adherence and lower average pressure than with fixed CPAP, with better self-reported sleep quality scores [18,20]. These findings suggest that while there may be minimal differences between CPAP and APAP for unselected patients, there may be groups of patients who may do better on APAP, including those with significant pressure variability, or those who require high therapeutic pressures.…”

Section: Apap As Treatment For Osamentioning

confidence: 91%

“…Most studies have shown only small differences in adherence between fixed CPAP and APAP. Early, small studies suggested that APAP may have advantages over CPAP in terms of adherence [18,19]. A more recent randomized 6-week trial in almost 200 unselected patients showed a more modest difference in adherence of 0.2 h per night (12 min) and a small difference in sleepiness between APAP and CPAP [20].…”

Section: Apap As Treatment For Osamentioning

confidence: 99%

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Advanced Positive Airway Pressure Modalities

Bierer¹,

Ryden

Aysola³

2015

Curr Sleep Medicine Rep

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Auto-adjusting positive airway pressure (PAP) devices are increasingly becoming the first line treatment for obstructive sleep apnea (OSA). More complex sleepdisordered breathing such as Cheyne-Stokes respirations and central sleep apnea related to heart failure as well as complex sleep-disordered breathing related to chronic hypoventilation syndromes may require the use of advanced positive airway pressure modalities such as automated servo ventilation (ASV) and volume targeted pressure limited ventilation. Identifying patients with complex sleep-disordered breathing that will benefit from treatment with advanced modalities remains an area of active investigation. A recent and surprising development found ASV to be associated with an increased risk of sudden cardiac death when used to treat central sleep apnea in patients with symptomatic systolic heart failure and an ejection fraction less than 45 %. The optimal treatment of central sleep apnea in heart failure and the role of ASV are currently in question. The following chapter is intended to provide the clinician with a description of newer PAP modalities; a review of evidence supported indications for use as well as provide a framework for managing patients with advanced positive airway pressure therapy.

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Section: Apap As Treatment For Osamentioning

confidence: 91%

Section: Apap As Treatment For Osamentioning

confidence: 99%

Advanced Positive Airway Pressure Modalities

Bierer¹,

Ryden

Aysola³

2015

Curr Sleep Medicine Rep

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“…Autotitrating CPAP devices automatically adjust the level of delivered pressure that is required to ensure upper airway patency. 24 Device usage was covertly monitored as 'time at pressure' and downloaded weekly.…”

Section: Continuous Positive Airway Pressure Implementationmentioning

confidence: 99%

The feasibility of using auto-titrating continuous positive airway pressure to treat obstructive sleep apnoea after acute tetraplegia

et al. 2009

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Study design: A prospective cohort with acute tetraplegia. Objectives: Obstructive sleep apnoea (OSA) is common within weeks of tetraplegia. This study aimed at determining the feasibility of auto-titrating continuous positive airway pressure (CPAP) to treat OSA after acute tetraplegia. Setting: The Victorian Spinal Cord Service, Melbourne, Australia Methods: Participants underwent full, portable polysomnography. Those with an apnoea hypopnoea index of more than 10 events per hour were defined as having OSA and were offered treatment with CPAP. Treatment adherence was objectively monitored, and measures of quality of life, sleepiness and functional outcomes were determined at enrolment and 3 months later at study conclusion. Results: A total of 44 patients were admitted to our Spinal Cord Service over 9 months, and 19 participated. Fourteen of them had OSA and seven were adherent with therapy for 3 months. Compared with those who did not have OSA, and with those with OSA who were not adherent with CPAP, those who adhered to CPAP were older (mean (s.d.) age 54 years (13) versus non-adherent 28 years (15) and no OSA 29 years (10)) and heavier (body mass index (BMI) 32.5 (11.7), 24.1 (3.7) and 20.6 (3.1), respectively). CPAP-adherant patients and those without OSA showed a 50% or greater improvement in their state sleepiness over the 3 months. Patients with OSA who did not tolerate CPAP had no improvement in sleepiness. Conclusion: Auto-titrating CPAP is a feasible treatment for OSA in acute tetraplegia. Intensive clinical support was required initially, and a tolerance of therapy for at least 4 h for one of the first 3 days was predictive of good CPAP usage. Sponsorship: Transport Accident Commission.

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“…Massie et al (30) found that during APAP, patients reported more restful sleep, better quality sleep, less discomfort from pressure and less trouble getting to sleep. Randerath et al (31) reported that 75% of responders preferred APAP.…”

Section: Treatmentmentioning

confidence: 99%

The Current Status of Autotitrating Continuous Positive Airway Pressure Systems in the Management of Obstructive Sleep Apnea

Hailey

Jacobs

Mayers

et al. 2005

Canadian Respiratory Journal

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BACKGROUND: Autotitrating continuous positive airway pressure (APAP) devices have the potential to address some of the disadvantages of titration and treatment with conventional continuous positive airway pressure (CPAP). Information on the performance of APAP in clinical use is still comparatively limited.OBJECTIVE: To assess the status of APAP devices in the management of obstructive sleep apnea (OSA) by reviewing evidence of their efficacy, effectiveness and costs.METHODS: A systematic search of electronic databases and a review of selected comparative studies on the use of APAP in the diagnosis, titration and treatment of OSA was undertaken. Cost analysis using data applicable to the management of OSA in Edmonton, Alberta was performed.RESULTS: Thirty-three studies met the selection criteria: three on the use of APAP in diagnosing OSA; six on APAP for titration; 14 that considered short-term treatment outcomes; and 10 that addressed longer-term treatment of OSA. In most studies, patients suffering from cardiac, pulmonary and other medical conditions were excluded. Available data suggested some potential for the use of APAP in the diagnosis of OSA, but further validation is needed. In titration, estimated treatment pressures tended to be lower with APAP than with the manual titration of CPAP. Although lower treatment pressures were achieved with APAP, there was no significant difference in clinical outcome measures between APAP and CPAP. Estimates of costs suggested that APAP may provide savings in some scenarios.CONCLUSIONS: APAP shows promise in the management of OSA; however, given the exclusion of some categories of patients from trials of this technology, caution is still required in its use.

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Comparison between Automatic and Fixed Positive Airway Pressure Therapy in the Home

Cited by 159 publications

References 36 publications

Advanced Positive Airway Pressure Modalities

Advanced Positive Airway Pressure Modalities

The feasibility of using auto-titrating continuous positive airway pressure to treat obstructive sleep apnoea after acute tetraplegia

The Current Status of Autotitrating Continuous Positive Airway Pressure Systems in the Management of Obstructive Sleep Apnea

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