Treatment of Obstructive Sleep Apnea With a Self-Titrating Continuous Positive Airway Pressure (CPAP) System

Sharma, Sat; Wali, Siraj; Pouliot, Zoe; Peters, Melissa J.; Neufeld, Herb; Kryger, Meir H.

doi:10.1093/sleep/19.6.497

Cited by 65 publications

(46 citation statements)

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“…APAP are also potentially cost-efficient auto-titrating systems [9,10]. Nevertheless, in some reports, failure of the APAP required manual resetting, whilst, in others, undesirable cardiorespiratory complications have been described [11][12][13][14].…”

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confidence: 99%

Bench testing of auto-adjusting positive airway pressure devices

Abdenbi¹

2004

Eur Respir J

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Continuous positive airway pressure devices are routinely used to treat sleep breathing disorders. Automated devices that adjust the therapeutic pressure have recently been proposed. The utility of such devices is still controversial, as rigorous clinical comparisons are difficult to perform as a result of patient and device differences.The current authors studied automated devices in a respiratory model that was able to mimic upper airway mechanics and to interact with pressure adjustment in a closed loop. Five auto-adjusted devices were submitted to this model, in order to determine their ability to detect respiratory events and adjust pressure accordingly.All apnoeas were suppressed, whilst the reaction to repetitive hypopnoeas was dependent on the airflow shape. In some devices, repetitive hypopnoeas were changed to flow limitation. Artificial snoring caused a pressure increase in four devices, and constant mask leak was not systematically compensated. Only one device did not raise pressure in response to central apnoeas with opened upper airways. These findings show that, in some devices, event classification failed and normal airflow was not fully restored, resulting in elevated residual event indices.In conclusion, this model is useful in order to reproducibly compare diagnostic and therapeutic capacities of commercial devices as a first step, before costly clinical studies.

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confidence: 99%

Bench testing of auto-adjusting positive airway pressure devices

Abdenbi¹

2004

Eur Respir J

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“…Some previous reports have indicated a preference towards APAP in treatment-naive patients [23,24], whereas others have reported no such preference [25,26]. However, the present study design was specifically chosen to directly compare these three APAP devices, an objective that would have been more difficult in treatment-naive patients.…”

Section: Discussionmentioning

confidence: 99%

Comparison of three auto-adjusting positive pressure devices in patients with sleep apnoea

Nolan

Ryan²,

O'Connor³

et al. 2006

Eur Respir J

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Auto-adjustable continuous positive airway pressure (APAP) devices are an emerging treatment alternative to fixed-pressure continuous positive airway pressure (CPAP) therapy for obstructive sleep apnoea syndrome. They have been engineered to automatically adjust the pressure to the optimal level on a continuous basis. However, not all APAP technologies use the same algorithm. Three different APAP devices (Autoset Spirit, Breas PV 10i and RemStar Auto) were compared in a randomised crossover trial in patients already established on fixed-pressure CPAP therapy. The outcome measures were compliance, quality of life and side-effects.Twenty-seven middle-aged patients (25 male) previously diagnosed with severe obstructive sleep apnoea syndrome (median (interquartile range) apnoea/hypopnoea index 48 (29-76)), established on CPAP therapy for .3 yrs, were randomised to each APAP device for 4 weeks.Mean pressure and patient compliance were significantly lower on the Breas PV 10i than on the other APAP devices. The devices were similar in terms of quality of life, daytime sleepiness and upper airway side-effects, but patients evaluated them significantly differently in terms of device features, sleep quality and pressure comfort, with the Breas PV 10i being the least popular.Auto-adjustable positive airway pressure devices differ in pressure delivery and patient compliance in obstructive sleep apnoea syndrome patients.

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“…In 12 studies (15)(16)(17)(18)(19)(20)(21)(22)(23)(26)(27)(28), there was no significant difference in AHI values, with scores for APAP being lower in four of the studies. In the other two studies (24,25), values for APAP were significantly higher than those for CPAP.…”

Section: Treatmentmentioning

confidence: 95%

“…In 12 studies (15)(16)(17)(18)(19)(20)(21)(22)(23)(24)26,28), there was a comparison of treatment pressures. APAP treatment produced significantly lower pressures than CPAP treatment in nine of the studies (15)(16)(17)(18)(21)(22)(23)26,28), and there was no significant difference in two studies (20,24). The remaining study (19) reported the maximum rather than the mean pressure for APAP, which was higher than that obtained with manual titration.…”

Section: Treatmentmentioning

confidence: 99%

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

Hailey

Jacobs

Mayers

et al. 2005

Canadian Respiratory Journal

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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.

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Treatment of Obstructive Sleep Apnea With a Self-Titrating Continuous Positive Airway Pressure (CPAP) System

Cited by 65 publications

References 0 publications

Bench testing of auto-adjusting positive airway pressure devices

Bench testing of auto-adjusting positive airway pressure devices

Comparison of three auto-adjusting positive pressure devices in patients with sleep apnoea

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

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