Auto-adjusting and fixed CPAP are equivalent for sleep apnea


By Reuters Staff

NEW YORK (Reuters Health) – Continuous positive airway pressure set at a fixed level (fCPAP) and CPAP with automatic mask-pressure adjustment (autoCPAP) are equally effective for treating obstructive sleep apnea (OSA), new research suggests.

“Taking the effectiveness and convenience of autoCPAP into account this treatment seems appropriate as first-line treatment for OSA syndrome,” Dr. Konrad Bloch of University Hospital Zurich, in Switzerland, and colleagues write in their October 5 online report in Thorax.

Fixed CPAP pressure is based on manual titration performed in the sleep lab. Computer-controlled CPAPs that continuously adjust mask pressure by feedback control are increasingly being used as an alternative to manual titration, and some doctors have begun using autoCPAP to treat patients. While these clinicians believe that autoCPAP will better meet patients’ changing mask-pressure needs, according to the researchers, to date no randomized controlled trials have compared the two approaches.

To bolster the existing evidence, the researchers randomly assigned 208 patients (mean age, 56; 87% men) to autoCPAP or fCPAP. Their median Epworth sleepiness score (ESS) was 13 (a score of 8 or higher signals excessive sleepiness).

By two years of treatment, the two groups each had improved by just over 6 ESS points. Changes in sleep resistance time also were similar between the groups, as were reductions in blood pressure.

Treatment-related costs with the two CPAP approaches were similar, although Dr. Bloch and his team note that because autoCPAP doesn’t require adjustment, it could be less costly in a real-world setting not subject to study protocols.

“These results support the use of autoCPAP as a convenient alternative to fCPAP in the long-term treatment of OSA syndrome,” they conclude.

Dr. Bloch was not available for an interview by press time.


Thorax 2017.

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