Auto-adjusted versus fixed positive airway pressure in patients with severe OSA: A large randomized controlled trial

BACKGROUND AND OBJECTIVE

Continuous positive airway pressure (CPAP) in the treatment of severe obstructive sleep apnoea (OSA) can be used in fixed CPAP or auto-adjusted (APAP) mode. The aim of this prospective randomized controlled clinical study was to evaluate the 3 month-efficacy of CPAP used either in fixed CPAP or APAP mode.

METHODS

Eight hundred one patients with severe OSA were included in twenty-two French centres. After 7 days during which all patients were treated with APAP to determine the effective pressure level and its variability, 353 and 351 patients were respectively randomized in the fixed CPAP group and APAP group. After 3 months of treatment, 308 patients in each group were analysed.

RESULTS

There was no difference between the two groups in terms of efficacy whatever the level of efficient pressure and pressure variability (p = 0.41). Exactly, 219 of 308 patients (71.1%) in the fixed CPAP group and 212 of 308 (68.8%) in the APAP group (p = 0.49) demonstrated residual apnoea hypopnoea index (AHI) <10/h and Epworth Score <11. Tolerance and adherence were also identical with a similar effect on quality of life and blood pressure evaluation.

CONCLUSION

The two CPAP modes, fixed CPAP and APAP, were equally effective and tolerated in severe OSA patients.

Ambulatory sleep recording in a healthcare network: a feasibility study

Sleep disorders have a high prevalence: around 20% of insomniacs, 10% hypersomnolent including 2 to 4% of sleep disordered breathing in the general adult population. The low availability of sleep centres implies the research of alternative recording techniques in the natural setting of the patient. The objective was to evaluate an ambulatory recorder and its integration in a managed healthcare network. Fifteen patients had a full set-up at home and ten patients were hooked-up in the hospital but recorded at home. Technical failures occurred in 2/15 with full polysomnographic recordings. Integration within an experimental sleep network is in progress. This managed care network will include training of general practitioners, teletransmissions between GP and sleep specialists for a graded use of available resources including ambulatory monitoring.