Evaluation of an auto-CPAP device for treatment of obstructive sleep apnoea

Ficker, Joachim H.; Wiest, Gunther H.; Lehnert, G.; Wiest, B; Hahn, Eckhart G.

doi:10.1136/thx.53.8.643

Cited by 57 publications

(51 citation statements)

References 21 publications

(11 reference statements)

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“…Starting from an initial 0.4 kPa (4 mbars), the pressure was increased in steps of 0.1 kPa (1 mbar) at intervals of o5 min when obstructive events (apnoeas, hypopnoeas or snoring) occurred. If no further events occurred during the next 30 min, the pressure was then reduced every 10 min in steps of 0.1 kPa (1 mbar) until they re-occurred, whereupon the pressure was increased once more in the manner described above [29]. On the second night of CPAP, the patients were treated with the minimum effective pressure established during the previous night.…”

Section: Continuous Positive Airways Pressure Therapymentioning

confidence: 99%

“…Diagnostic polysomnographies were performed in the sleep laboratory by trained sleep laboratory technicians as described previously [29]. All variables were recorded on a computer (SleepLab, Jaeger and Toennies, Hoechburg, Germany), and included electroencephalography (C4/A1, C3/A2), bilateral electrooculography, submental electromyography, nasal airflow measured by oronasal thermistors, snoring detected by microphone, electrocardiography, thoracic and abdominal movements measured by uncalibrated inductive plethysmography, and oxyhaemoglobin saturation using a finger oxymeter (Microspan1 3040G; Jaeger and Toennies).…”

Section: Sleep Studiesmentioning

confidence: 99%

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Leptin and ghrelin levels in patients with obstructive sleep apnoea: effect of CPAP treatment

Harsch¹,

Konturek²,

Koebnick³

et al. 2003

European Respiratory Journal

252

165

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Serum leptin and ghrelin levels were investigated in patients with obstructive sleep apnoea (OSA) syndrome before and during continuous positive airways pressure (CPAP) treatment and compared with body mass index (BMI)-matched controls without OSA.Male patients (n=30) with OSA (apnoea/hypopnoea index=58 ¡ 16, BMI=32.6 ¡ 5.3 kg?m -2 ) underwent CPAP treatment. Fasting leptin and ghrelin were measured at baseline and 2 days, and in the case of leptin 2 months after initiation of treatment.Baseline plasma ghrelin levels were significantly higher in OSA patients than in controls. After 2 days of CPAP treatment, plasma ghrelin decreased in almost all OSA patients (n=9) to levels that were only slightly higher than those of controls (n=9). Leptin levels did not change significantly from baseline after 2 days of CPAP treatment, but were higher than in the control group. After 8 weeks, leptin levels decreased significantly, although the BMI of the patients showed no change. The decrease in leptin levels was more pronounced in patients with a BMI v30 kg?m -2 . These data indicate that the elevated leptin and ghrelin levels are not determined by obesity alone, since they rapidly decreased during continuous positive airways pressure therapy. Eur Respir J 2003; 22: 251-257 Obstructive sleep apnoea (OSA) is a common disorder affecting 2-4% of the adult population [1]. OSA is strongly associated with obesity. In a recent study involving 773 patients with OSA, only 6.5% had a normal body mass index (BMI), while 75.2% were obese (BMIo30 kg?m -2 ) [2]. Patients with OSA appear to be more likely to put on weight than equally obese subjects without OSA [3]. The mechanisms underlying this phenomenon remain obscure. Recently, a number of authors have speculated that changes in serum leptin levels or leptin-receptor insensitivity may be involved in the pathogenesis of progressive obesity in patients with OSA [4]. Leptin has been found to reduce appetite and simultaneously to increase respiratory drive in an animal model [5,6]. In humans, the situation may be expected to be more complicated. In recent studies, fasting leptin levels in patients with OSA decreased after initiation of continuous positive airways pressure (CPAP) treatment [7,8]. However, those leptin measurements were performed on awake individuals in the morning, when the respiratory situation was normalised, so that any linkage between leptin levels and respiratory effects is difficult in this setting. Furthermore, leptin levels are influenced by a multitude of factors, such as sex, body weight [9,10], the presence of hypertension, or specific medications impacting on leptin levels. Diurnal and ultradian variations in serum leptin levels are further factors complicating profound insights concerning significant respiratory effects [11][12][13].However, the finding that a hormone like leptin is able to cover a variety of biological functions, beyond its well-investigated role for the regulation of body weight and energy expenditure, also prompted the present aut...

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Section: Continuous Positive Airways Pressure Therapymentioning

confidence: 99%

Section: Sleep Studiesmentioning

confidence: 99%

Leptin and ghrelin levels in patients with obstructive sleep apnoea: effect of CPAP treatment

Harsch¹,

Konturek²,

Koebnick³

et al. 2003

European Respiratory Journal

252

165

View full text Add to dashboard Cite

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“…Some previous reports have indicated a preference towards APAP in treatment-naive patients [23,24], whereas others have reported no such preference [25,26]. However, the present study design was specifically chosen to directly compare these three APAP devices, an objective that would have been more difficult in treatment-naive patients.…”

Section: Discussionmentioning

confidence: 99%

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

Nolan

Ryan²,

O'Connor³

et al. 2006

European Respiratory Journal

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Auto-adjustable continuous positive airway pressure (APAP) devices are an emerging treatment alternative to fixed-pressure continuous positive airway pressure (CPAP) therapy for obstructive sleep apnoea syndrome. They have been engineered to automatically adjust the pressure to the optimal level on a continuous basis. However, not all APAP technologies use the same algorithm. Three different APAP devices (Autoset Spirit, Breas PV 10i and RemStar Auto) were compared in a randomised crossover trial in patients already established on fixed-pressure CPAP therapy. The outcome measures were compliance, quality of life and side-effects.Twenty-seven middle-aged patients (25 male) previously diagnosed with severe obstructive sleep apnoea syndrome (median (interquartile range) apnoea/hypopnoea index 48 (29-76)), established on CPAP therapy for .3 yrs, were randomised to each APAP device for 4 weeks.Mean pressure and patient compliance were significantly lower on the Breas PV 10i than on the other APAP devices. The devices were similar in terms of quality of life, daytime sleepiness and upper airway side-effects, but patients evaluated them significantly differently in terms of device features, sleep quality and pressure comfort, with the Breas PV 10i being the least popular.Auto-adjustable positive airway pressure devices differ in pressure delivery and patient compliance in obstructive sleep apnoea syndrome patients.

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“…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.…”

Section: Treatmentmentioning

confidence: 99%

“…In 12 studies (15)(16)(17)(18)(19)(20)(21)(22)(23)(24)26,28), there was a comparison of treatment pressures. APAP treatment produced significantly lower pressures than CPAP treatment in nine of the studies (15)(16)(17)(18)(21)(22)(23)26,28), and there was no significant difference in two studies (20,24). The remaining study (19) reported the maximum rather than the mean pressure for APAP, which was higher than that obtained with manual titration.…”

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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Evaluation of an auto-CPAP device for treatment of obstructive sleep apnoea

Cited by 57 publications

References 21 publications

Leptin and ghrelin levels in patients with obstructive sleep apnoea: effect of CPAP treatment

Leptin and ghrelin levels in patients with obstructive sleep apnoea: effect of CPAP treatment

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

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

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