Continuous positive airway pressure titration for obstructive sleep apnoea: automatic versus manual titration

Abstract

Background and aims Manual laboratory continuous positive airway pressure (CPAP) titration for obstructive sleep apnoea (OSA) is costly, time intensive and delays access to treatment. Automatic positive airway pressure (APAP) titration has the potential to reduce cost and improve access to treatment. The aim of this study was to assess the clinical efficacy and costs of APAP titration compared with manual titration in moderateesevere OSA. Methods Patients with moderateesevere OSA (apnoea/ hypopnoea index >15 and Epworth Sleepiness Score $8) who were free of co-morbidities that could impair APAP titration were eligible. 249 participants were randomised to manual titration, home APAP or laboratory APAP titration to determine a fixed pressure for CPAP. Clinical and direct cost outcomes were assessed after 4 weeks of treatment. Results Average nightly CPAP use, subjective sleepiness, SF36 quality of life, Trails A and B cognitive function and polysomnographic outcomes were similar among the per-protocol groups. Non-hypertensive patients had a lower resting heart rate (and greater reduction in heart rate) at 4 weeks after laboratory APAP titration compared with home APAP titration. Costs per patient were highest in manual (AU$817.84), followed by laboratory (AU$647.56) and home (AU$132.09) APAP titration. An intention-to-treat analysis confirmed the effectiveness of APAP titration compared with manual titration in the standard clinical setting. Conclusions Among patients with moderateesevere OSA without serious co-morbidities, outcomes at 1 month indicate that APAP titration is more cost-effective than manual laboratory titration to determine an appropriate pressure for CPAP for long-term use; with the largest savings occurring in the home APAP patients. Australian New Zealand Clinical Trials Registry Number ACTRN12608000054314.

Terapias ventilatorias domiciliarias en el síndrome de apnea-hipopnea del sueño

“…La estimación aproximada de coste por noche de estudio con titulación manual fue de 817 $, frente a los 647 $ del ajuste con auto-CPAP en el laboratorio, o a los 132 $ para el ajuste de auto-CPAP en domicilio. Un análisis por intención de tratar confirmó la eficacia de la titulación mediante auto-CPAP comparada con la titulación manual 48 .…”

Ambulatory monitoring in the diagnosis and management of obstructive sleep apnoea syndrome

“…However, auto-CPAP and predicted formula titration could lead to considerable savings and significant reductions in waiting lists. In this respect, MCARDLE et al [85] reported that the total costs for auto-CPAP titration was much lower than those of laboratory auto-CPAP (less than one-third).…”

Immediate effect of CPAP titration on perceived health related quality of life: a prospective observational study

“…CPAP is usually set at a pressure sufficient to prevent upper airway collapse in all body positions and sleep stages. CPAP titration is determined by an attended overnight CPAP titration study with full polysomnographic (PSG) monitoring in a sleep laboratory, or by automatic positive airway pressure (APAP) devices [7–9]. …”