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

Nolan, Geraldine; Ryan, Suzanne; O'Connor, Terry; McNicholas, Walter T.

doi:10.1183/09031936.06.00127205

Cited by 34 publications

(21 citation statements)

References 28 publications

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“…The authors concluded that, in general, A-CPAP therapy does not offer advantages in the evaluated outcomes over fixed-pressure CPAP and the latter remains the standard for PAP treatment. More recent clinical studies addressing this question (104,(107)(108)(109)(110)(111) have not provided evidence to warrant modification of this conclusion. RCTs are clearly needed to determine whether there are subpopulations of patients with OSAH that would derive outcome and adherence benefit from A-CPAP therapy.…”

Section: Treatment Of Osah With Pap Modalities Other Than Fixed-pressmentioning

confidence: 97%

Positive Pressure Therapy: A Perspective on Evidence-based Outcomes and Methods of Application

Sanders¹,

Montserrat²,

Farré³

et al. 2008

Proceedings of the American Thoracic Society

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The sleep medicine community has increasingly recognized the necessity that clinical care be based on high-quality levels of evidence. Although research supports a favorable influence of positive airway pressure (PAP) therapy on risk for significant adverse outcomes in patients with severe obstructive sleep apnea-hypopnea (OSAH), welldesigned trials are still required to elucidate the effect of PAP on health, quality of life, and economic risks in patients with milder OSAH. Similarly, although there is strong evidence supporting various PAP titration strategies and PAP modalities in patients with severe OSAH without significant medical and psychiatric comorbidities, there is insufficient high-level evidence assessing and comparing the clinical efficacy and health care cost implications of various titration paradigms and various PAP modalities in individuals with milder OSAH and those with comorbid conditions. For ethical and other reasons, it may not be possible to apply a randomized controlled design to address all questions. However, whichever design is employed, it must be rigorously developed with attention to all potential confounders with adequate power to provide compelling, high-quality evidence.Keywords: obstructive sleep apnea; positive airway pressure; therapy of sleep apnea Wright and colleagues generated considerable self-examination within the field of sleep medicine with the publication of their literature review of the health consequences of obstructive sleep apnea-hypopnea (OSAH) and the effectiveness of continuous positive airway pressure (CPAP) therapy for this disorder (1). The authors concluded that perhaps with the exception of reducing sleepiness and motor vehicle crashes, evidence of benefit from treatment with CPAP was, at best, weak. Wright and coworkers supported their contention by citing numerous flaws in the studies that were published to that time. Inadequacies were identified in research design and analyses, including lack of randomized controlled trials, as well as failure to account for carryover effects and potential confounders.It is evident that well-designed and conducted randomized controlled trials (RCTs) yield high-quality evidence, but they carry costs as well as benefits. Several authors (2-4) have asserted that the hierarchy of research design quality, as reflected by the evidence-grading pyramid, is flawed and artificial, with the results of many well-done non-RCTs withstanding the test of time. It has been further argued that RCT design may rigidly restrict the intervention to a single paradigm, whereas in clinical practice, physicians adjust therapies according to the specific clinical features of individual patients (2, 4). Thus, the generalizability of the results of randomized controlled clinical trials to clinical care may be imperfect. Moreover, these authors contended that similar evidence from more than one, well-done observational study usually corroborates the results of an RCT examining the same issue. RCTs are also usually costly (5) and, if comparably re...

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Section: Treatment Of Osah With Pap Modalities Other Than Fixed-pressmentioning

confidence: 97%

Positive Pressure Therapy: A Perspective on Evidence-based Outcomes and Methods of Application

Sanders¹,

Montserrat²,

Farré³

et al. 2008

Proceedings of the American Thoracic Society

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“…Some of these systems can also provide information about the residual apneas or hypopneas while patients are on CPAP (i.e., automated CPAP) ( Figure 1B) [36,37] . Although treatment with automated CPAP improves patient satisfaction and compliance in a subset of patients with obstructive sleep apnea (OSA), the routine use of automated CPAP for OSA treatment provides limited benefit [38][39][40] . Furthermore, although Figure 1 Effects of positive airway pressure on hemodynamics.…”

Section: Cpapmentioning

confidence: 99%

Positive airway pressure therapy for heart failure

Kato

Suda

Kasai

2014

WJC

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“…Comparative trials of A-CPAP versus F-CPAP, as well as between different A-CPAP devices with respect to compliance and subjective preference, have provided equivocal results. Some studies report similar effects, while others point out significant differences [33,36,[40][41][42][43][45][46][47][48][49][50]. Once again, when differences were found, they were often small and appeared unrelated to delivered pressure levels.…”

Section: Do Different A-cpap Devices Perform Equally?mentioning

confidence: 87%

“…Studies on patients with OSAHS showed that levels and variability of pressure delivered by the A-CPAP devices can be different [32][33][34][35][36], sometimes to a considerable extent. However, despite differences in pressure output the effects on polysomnographic variables prove to be similar for most A-CPAP devices.…”

Section: Do Different A-cpap Devices Perform Equally?mentioning

confidence: 99%

Treatment of obstructive sleep-disordered breathing with positive airway pressure systems

Pevernagie¹,

Masa²,

Meurice³

et al. 2007

European Respiratory Review

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Positive airway pressure systems are widely used to treat patients with moderate-tosevere obstructive sleep-disordered breathing. The application of stable continuous positive airway pressure (CPAP) via the nose (nasal CPAP) has been the mainstay of treatment since the early 1980s. For treatment to be effective, the pressure level must be fine-tuned to restore patency of the individual patient's upper airway.Currently, there is ongoing controversy concerning which outcomes to observe when adapting the pressure level, and which methods to use for pressure adaptation. Adjusting the pressure level to control apnoeas and hypopnoeas is one major objective, but may not be sufficient to restore normal sleep. Evidence is available that elimination of inspiratory flow limitation leads to better results.In recent years, it has become evident that the use of empirically set CPAP or automatic CPAP devices parallel the clinical results obtained with the classical approach of manual CPAP titration. A striking and still unexplained paradox lies in the fact that automatic CPAP devices perform very differently on the bench, but still yield satisfactory results on several clinical outcomes, e.g. control of sleep-related respiratory disturbances, restoration of good sleep quality and daytime alertness. Understanding the functioning of automatic CPAP devices can prove difficult, as the mode of operation is usually not disclosed by the manufacturers.At present, it is impossible to make any scientifically sound statement on the appropriateness of using automatic continuous positive airway pressure devices for the routine treatment of patients with obstructive sleep-disordered breathing. For this purpose, convincing results of phase I-III clinical trials are needed.

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

Cited by 34 publications

References 28 publications

Positive Pressure Therapy: A Perspective on Evidence-based Outcomes and Methods of Application

Positive Pressure Therapy: A Perspective on Evidence-based Outcomes and Methods of Application

Positive airway pressure therapy for heart failure

Treatment of obstructive sleep-disordered breathing with positive airway pressure systems

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