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

Abstract

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.

Relationships between MRI fat distributions and sleep apnea and obesity hypoventilation syndrome in very obese patients

“…The AHI is influenced by the anatomic susceptibility of the upper airway to collapse along with dilator muscle responsiveness and other factors [ 8 ]. Autotitrating CPAP (autoCPAP), in addition to commonly being used in the treatment of OSA [ 9 ], delivers interesting information about upper airway function. AutoCPAP machines vary between models, but all increase the delivered pressure in response to residual obstructive events (snoring, hypopnea, apnea and flow limitation) [ 10 , 11 ].…”

Severe OSA Leading to Long Pauses in 24-h Holter ECG Reversed with CPAP

“…All the breaths of a patient in CPAP are self-initiated, and no additional pressure is provided above the set level. CPAP is delivered through several methods, such as nasal CPAP, nasopharyngeal CPAP, and face mask [ 16 ]. A combination treatment of CPAP and surgery has been applied to lose weight as a part of the treatment of severe OSA.…”

A pilot study: portable out-of-center sleep testing as an early sleep apnea screening tool in acute ischemic stroke

“… 57 With appropriate clinical prescreening (eg, STOP BANG questionnaire), the portable OCST could be utilized as a screening or “disease-finding” tool to assist early delivery of positive airway pressure (PAP) therapy to acute stroke patients with OSA. 58 – 66 A potentially practical approach to screening and testing for SA in the acute setting is presented in Figure 4 . This approach, after appropriate validation by randomized controlled trials, can also be potentially applied in any acute hospital setting in patients with a high SA probability, which may create a new opportunity for the development of combined acute sleep medicine protocols, providing a new role for sleep medicine centers in bedside in-hospital diagnosis and treatment of SA.…”