Computerized Adjustable Versus Fixed NCPAP Treatment of Obstructive Sleep Apnea

Abstract

An automated positive airway pressure device that monitors respiratory patterns and provides dynamic, real-time, relational pressure has been developed for the treatment of obstructive sleep apnea (OSA). The purpose of this study was to compare self-adjusting pressure to classical nasal continuous positive airway pressure (NCPAP). Subjects were newly diagnosed patients with a minimum respiratory disturbance index (RDI) of 15 episodes per hour who had undergone NCPAP titration and been using classical NCPAP at home on a nightly basis for at least 2 weeks. Patients then underwent repeat standard polysomnographic (PSG) evaluations for 2 nights using a self-adjusting pressure mode and a standard NCPAP mode randomly assigned in a single-blind crossover fashion. Eight males and four females (n = 12), aged 48.4 +/- 12.2 years [mean +/- and standard deviation (SD)], completed the study. During initial diagnostic PSG, the RDI was 57.3 +/- 30.8 episodes per hour. The RDI and minimum oxygen saturation for both treatment nights were significantly improved from those of the diagnostic PSGs (p < 0.001). The subjects spent 63.1 +/- 34.2% of total sleep time below prescribed pressure while on automatic pressure Percent of total sleep time in stage 3/4 sleep was significantly higher during self-adjusting pressure, at 8.6 +/- 7.5%, compared to standard NCPAP, at 4.6 +/- 6.0% (p < 0.05). Computerized adjustable nasal positive airway pressure effectively controls OSA, fluidly providing the minimal pressure necessary to control respiratory events without causing sleep disruption.

Automatic CPAP titration with different self-setting devices in patients with obstructive sleep apnoea

“…A further cause of the relatively poor results with fixed CPAP in these studies may be that the AHI of the manual titration night, with longer periods of ineffective fixed nCPAP, was compared with the results of automatic CPAP. SCHARF et al [27], using a study design similar to that in the present study, also found a lower AHI with fixed CPAP compared to automatic CPAP (the Horizon), although the results of the two treatment modalities did not differ significantly.…”

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

“…There was no significant difference in sleep architecture measures for eight of nine studies. In one study (27), there was a significantly higher stage 3 and 4 sleep for the group who received APAP. There was no significant difference in arousal index scores in 11 studies (15-23,25,26,28) or for sleep time in three studies (18,25,26).…”

“…In 12 studies (15)(16)(17)(18)(19)(20)(21)(22)(23)(26)(27)(28), there was no significant difference in AHI values, with scores for APAP being lower in four of the studies. In the other two studies (24,25), values for APAP were significantly higher than those for CPAP.…”

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

“…However, despite differences in pressure output the effects on polysomnographic variables prove to be similar for most A-CPAP devices. All of the published reports demonstrate effectiveness in reducing, and usually normalising, obstructive respiratory disorders and sleep fragmentation [11,[33][34][35][37][38][39][40][41][42][43][44][45][46][47]. Although in some reports significant differences were found, they were small in absolute terms.…”