Comparison of manual and automatic CPAP titration in patients with sleep apnea/hypopnea syndrome.

Abstract

Automatic CPAP (auto-CPAP) is engineered to automatically provide a positive pressure to the upper airway in response to apnea, hypopnea, airflow limitation, or snoring in patients with the sleep apnea/ hypopnea syndrome (SAHS). Self-adjusted CPAP has theoretical advantages over traditional fixed CPAP. We investigated the value of auto-CPAP regulation in 20 patients with SAHS in order to predict future fixed-level CPAP needs, as an alternative method to conventional polysomnographically (PSG)-controlled CPAP titration. This was accomplished through comparison of the optimal CPAP level obtained with PSG with that obtained with auto-CPAP. There were no significant differences between the optimal CPAP level achieved with full PSG or with auto-CPAP. As a secondary analysis, we analyzed auto-CPAP performance with regard to sleep-stage distribution and arousals in a group of nine male patients, and compared it with the previous group of 20 patients in which manually CPAP titration was guided by PSG. After adequate CPAP was reached, upward and downward fluctuations in the CPAP level had no significant effect on sleep architecture or fragmentation. We conclude that auto-CPAP permits the prediction of future fixed-level CPAP needs, and does so without sleep disruption.

Auto-CPAP: an effective and low-cost procedure in the management of OSAS?

“…An alternative is to automate the titration process and determine a single pressure suitable for subsequent at-home fixed pressure treatment. The validity of such a strategy in correcting sleep breathing disorders has been demonstrated when compared with manual titration [8,9]. However, whether this permits a substantial reduction in or abolition of laboratory-based tests needed to titrate CPAP in OSA patients remains unknown.…”

Bench testing of auto-adjusting positive airway pressure devices

“…Auto-adjusting positive airway pressure (APAP) systems have been developed and clinically tested for several years [1][2][3][4][5][6][7]. They are aimed at improving effectiveness and, possibly, reducing side-effects of CPAP by providing optimal pressure, which is found, on average, to be lower than a continuous level [8].…”

Efficacy of daytime continuous positive airway pressure titration in severe obstructive sleep apnoea

“…While this approach offers many advantages, it is time-consuming and expensive. A variety of alternative approaches have been described including: split-night diagnostic/titration studies [2][3][4][5][6], laboratory titration using automated nCPAP devices [7][8][9][10], home attended manual or unattended automated titration [11][12][13], and empiric treatment using prediction formulae [14]. Studies to date have indicated that there are potential advantages, but also limitations, to each of these approaches; and considerable work is required to establish the shortand long-term therapeutic efficacy of these alternate methods.…”