Auto-adjusted versus fixed positive airway pressure in patients with severe OSA: A large randomized controlled trial.
CPAP
OSA
auto-adjusted mode
continuous positive airway pressure
efficacy
fixed pressure
severe obstructive sleep apnoea
tolerance
Journal
Respirology (Carlton, Vic.)
ISSN: 1440-1843
Titre abrégé: Respirology
Pays: Australia
ID NLM: 9616368
Informations de publication
Date de publication:
11 2023
11 2023
Historique:
received:
07
02
2023
accepted:
24
07
2023
medline:
23
10
2023
pubmed:
17
8
2023
entrez:
16
8
2023
Statut:
ppublish
Résumé
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. 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. 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. The two CPAP modes, fixed CPAP and APAP, were equally effective and tolerated in severe OSA patients.
Sections du résumé
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.
Types de publication
Randomized Controlled Trial
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1069-1077Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2023 Asian Pacific Society of Respirology.
Références
Punjabi NM, Caffo BS, Goodwin JL, Gottlieb DJ, Newman AB, O'Connor GT, et al. Sleep-disordered breathing and mortality: a prospective cohort study. PLoS Med. 2009;6(8):e1000132.
Mar J, Rueda JR, Duran-Cantolla J, Schechter C, Chilcott J. The cost-effectiveness of nCPAP treatment in patients with moderate-to-severe obstructive sleep apnea. Eur Respir J. 2003;21(3):515-522.
McDaid C, Griffin S, Weatherly H, Durée K, Van der Burgt M, Van Hout S, et al. Continuous positive airway pressure devices for the treatment of obstructive sleep apnoea-hypopnoea syndrome: a systematic review and economic analysis. Health Technol Asses. 2009;13(4):1-119. 143-274.
Giles TL, Lasserson TJ, Smith BJ, Wright J, Cates CJ. Continuous positive airways pressure for obstructive sleep apnea in adults. Cochrane Database Syst Rev. 2006;3:CD001106.
Alajmi M, Mulgrew AT, Fox J, Davidson W, Schulzer M, Mak E, et al. Impact of continuous positive airway pressure therapy on blood pressure in patients with obstructive sleep apnea hypopnea: a meta-analysis of randomized controlled trials. Lung. 2007;185(2):67-72.
Meurice JC, Paquereau J, Denjean A, Patte F, Series F. Influence of correction of flow limitation on continuous positive airway pressure efficiency in sleep apnea/hypopnea syndrome. Eur Respir J. 1998;11(5):1121-1127.
West SD, Jones DR, Stradling JR. Comparison of three ways to determine and deliver pressure during nasal CPAP therapy for obstructive sleep apnea. Thorax. 2006;61:226-231.
Morgenthaler TI, Aurora RN, Brown T, Zak R, Alessi C, Boehlecke B, et al. Practice parameters for the use of auto titrating continuous positive airway pressure devices for titrating pressures and treating adult patients with obstructive sleep apnea syndrome: an update for 2007. An American Academy of Sleep Medicine report. Sleep. 2008;31:141-147.
Senn O, Brack T, Matthews F, Russi EW, Bloch KE. Randomized short-term trial of two AutoCPAP devices versus fixed continuous positive airway pressure for the treatment of sleep apnea. Am J Respir Crit Care Med. 2003;168(12):1506-1511.
d'Ortho MP, Grillier-Lanoir V, Levy P, Goldenberg F, Corriger E, Harf A, et al. Constant vs. automatic continuous positive airway pressure therapy: home evaluation. Chest. 2000;118(4):1010-1017.
Ip S, D'Ambrosio C, Patel K, Obadan N, Kitsios GD, Chung M, et al. Auto-titrating versus fixed continuous positive airway pressure for the treatment of obstructive sleep apnea: a systematic review with meta-analyses. Syst Rev. 2012;1:20.
Nussbaumer Y, Bloch KE, Genser T, Thurnheer R. Equivalence of autoadjusted and constant continuous positive airway pressure in home treatment of sleep apnea. Chest. 2006;129(3):638-643.
Massie CA, McArdle N, Hart RW, Schmidt-Nowara WW, Lankford A, Hudgel DW, et al. Comparison between automatic and fixed positive airway pressure therapy in the home. Am J Respir Crit Care Med. 2003;167:20-23.
Series F, Marc I. Importance of sleep stage- and body position-dependence of sleep apnea in determining benefits to auto-CPAP therapy. Eur Respir J. 2001;18(1):170-175.
Noseda A, Kempenaers C, Kerkhofs M, Braun S, Linkowski P, Jann E. Constant vs auto-continuous positive airway pressure in patients with sleep apnea hypopnea syndrome and a high variability in pressure requirement. Chest. 2004;126:31-37.
Smith I, Lasserson TJ. Pressure modification for improving usage of continuous positive airway pressure machines in adults with obstructive sleep apnoea. Cochrane Database Syst Rev. 2009;(4):CD003531.
Kennedy B, Lasserson TJ, Wozniak DR, Smith I. Pressure modification or humidification for improving usage of continuous positive airway pressure machines in adults with obstructive sleep apnoea. Cochrane Database Syst Rev. 2019;12(12):CD003531.
Fava C, Dorigoni S, Dalle Vedove F, Danese E, Montagnana M, Guidi GC, et al. Effect of CPAP on blood pressure in patients with OSA/hypopnea a systematic review and meta-analysis. Chest. 2014;145(4):762-771.
Pépin JL, Tamisier R, Baguet JP, Lepaulle B, Arbib F, Arnol N, et al. Fixed-pressure CPAP versus auto-adjusting CPAP: comparison of efficacy on blood pressure in obstructive sleep apnoea, a randomised clinical trial. Thorax. 2016;71:726-733.
Dursunoğlu N, Dursunoğlu D, Cuhadaroğlu C, Kiliçaslan Z. Acute effects of automated continuous positive airway pressure on blood pressure in patients with sleep apnea and hypertension. Respiration. 2005;72(2):150-155.
Patruno V, Aiolfi S, Costantino G, Murgia R, Selmi C, Malliani A, et al. Fixed and autoadjusting continuous positive airway pressure treatments are not similar in reducing cardiovascular risk factors in patients with obstructive sleep apnea. Chest. 2007;131:1393-1399.
Robinson GV, Smith DM, Langford BA, Davies RJO, Stradling JR. Continuous positive airway pressure does not reduce blood pressure in nonsleepy hypertensive OSA patients. Eur Respir J. 2006;27(6):1229-1235.
Patruno V, Tobaldini E, Bianchi AM, Mendez MO, Coletti O. Acute effects of autoadjusting and fixed continuous positive airway pressure treatments on cardiorespiratory coupling in obese patients with obstructive sleep apnea. Eur J Intern Med. 2014;25:164-168.
Series F, Plante J, Lacasse Y. Reliability of home CPAP titration with different automatic CPAP devices. Respir Res. 2008;9:56.
Bachour A, Virkkala JT, Maasilta PK. AutoCPAP initiation at home: optimal trial duration and cost-effectiveness. Sleep Med. 2007;8:704-771.
Verbraecken J, Willemen M, De Cock W, Van de Heyning P, De Backer WA. Continuous positive airway pressure and lung inflation in sleep apnea patients. Respiration. 2001;68(4):357-364. https://doi.org/10.1159/000050527