Constant vs automatic continuous positive airway pressure therapy - Home evaluation

Study objectives: To compare the efficacy and patient tolerance, compliance , and preference between auto-continuous positive airway pressure (CPAP) an d constant CPAP. Design: Single-blinded, crossover, cohort study of consecutive patients wit h obstructive sleep apnea syndrome, with two treatment periods of 2 months each. Patients: Twenty-five patients (22 men, 3 women) with sleep apnea syndrome confirmed by ambulatory polysomnography. Measurements and interventions: After baseline polysomnography, patients un derwent in-laboratory polysomnography for titration of constant CPAP. The o rder of treatment was randomly allocated, either auto-CPAP and then constan t CPAP, or rice versa. The auto-CPAP pressure range was 6 to 16 cm H2O. At the end of each 2-month period, patients underwent a control ambulatory pol ysomnography and received a questionnaire oil subjective well-being and dev ice evaluation. Duration of use was checked through CPAP device monitoring. Results: Rio differences were found in apnea/hypopnea index (constant CPAP, 9.7 +/- 1.9 events/h vs auto-CPAP, 10.6 +/- 9.3 events/h), awakening/arous al index (constant CPAP, 13.7 +/- 8.0 events/h vs auto-CPAP, 15.5 +/- 8.9 e vents/h), slow-wave sleep duration, nocturnal saturation, or complaint of d aytime sleepiness. The mean pressure required was significantly lower durin g auto-CPAP than during constant CPAP (8.8 +/- 1.8 cm H2O vs 9.7 +/- 2.6 cm H2O, respectively). Patient tolerance, compliance, and duration of use wer e similar with both treatments. Conclusions: Auto-CPAP is as effective as constant CPAP. A wide pressure ra nge for auto-CPAP can be used in all patients, suggesting that, in the futu re, use of a broad pressure range in the auto-CPAP mode could obviate the n eed for the titration night.