Comparison of automatic and continuous positive airway pressure in a night-by-night analysis: a randomized, crossover study.

BACKGROUND

Long-term compliance is suboptimal in the treatment of the obstructive sleep apnea syndrome (OSAS).

OBJECTIVES

We compared the efficacy of and the adherence to automatic continuous positive airway pressure (APAP) and constant continuous positive airway pressure (CPAP) based on a night-by-night analysis.

METHODS

We performed a randomized, single-blind crossover study in 20 patients with moderate-to-severe OSAS. After diagnostic polysomnography and manual titration, patients were treated for 8 weeks with both constant CPAP and APAP in random order. Compliance and leakage were analyzed night by night using the software LOGSoft of the Magellan iPAP device.

RESULTS

The reduction in the apnea/hypopnea index (baseline 32.9 +/- 19.1/h, CPAP 4.6 +/- 2.9/h, APAP 5.6 +/- 3.6/h; p < 0.001 compared to baseline) and the Epworth Sleepiness Scale (baseline 10.3 +/- 5.7, CPAP 6.6 +/- 4.8, APAP 4.9 +/- 4.6; p < 0.001 compared to baseline) did not significantly differ between the treatment modes. Leakage time and compliance per night were not statistically different (leakage CPAP 31 +/- 57 min, APAP 25 +/- 49 min; compliance CPAP 383 +/- 116 min, APAP 382 +/- 107 min). There was no correlation between leakage and compliance. Thirteen patients (65%) preferred APAP at the end of the study.

CONCLUSIONS

Treatment efficacy and adherence are similar with CPAP and APAP. There is a trend towards lower leakage with APAP therapy. Patients prefer the automatic mode to fixed pressure.