Autoadjusting CPAP therapy based on impedance efficacy, compliance and acceptance

• Published in: American journal of respiratory and critical care medicine Vol. 163; no. 3; pp. 652 - 657
• Main Authors: RANDERATH, Winfried J, SCHRAEDER, Oliver, GALETKE, Wolfgang, FELDMEYER, Frank, RÜHLE, Karl-Heinz
• Format: Journal Article
• Language: English
• Published: New York, NY American Lung Association 01.03.2001
• Subjects: Biological and medical sciences; Cross-Over Studies; Electric Impedance; Female; Humans; Male; Medical sciences; Middle Aged; Patient Compliance - statistics & numerical data; Pneumology; Positive-Pressure Respiration - methods; Prospective Studies; Respiratory system : syndromes and miscellaneous diseases; Sleep Apnea, Obstructive - therapy; Human; Evaluation; Nervous system diseases; Sleep apnea syndrome; Automated equipment; Respiratory disease; Continuous; Treatment efficiency; Sleep disorder; Respiratory tract; Treatment; Positive pressure; Treatment compliance
• ISSN: 1073-449X; 1535-4970
• DOI: 10.1164/ajrccm.163.3.2006168

Constant continuous positive airway pressure (CPAP) is the treatment of choice for the obstructive sleep apnea syndrome (OSAS). To enable the pressure to be matched more accurately to actual requirements, and thus increase patient acceptance, an autoadjusting device based on the measurement of upper airway impedance was developed (APAP(FOT)). We investigated the efficacy and compliance in continuous use at home. Fifty-two patients were treated (randomized crossover) with CPAP and APAP(FOT) for 6 wk each. Respiratory disturbances, sleep profile, and arousals improved significantly with both modes (AHI: baseline, 35.1 +/- 26/h; APAP(FOT), 5.0 +/- 5.2; CPAP, 4.3 +/- 6.3; p < 0.001 baseline versus each mode). The mean pressure with APAP(FOT) was significantly reduced as compared with CPAP (CPAP, 7.8 +/- 1.5 cm H2O; APAP(FOT), 5.7 +/- 1.8 cm H2O; p < 0.001). Under APAP(FOT) the pressure was lower than that under CPAP for 81.5 +/- 21% of the time. Although overall use did not differ, 75% of the patients preferred APAP(FOT) for home treatment. We conclude that APAP(FOT) is as efficacious as constant CPAP in the treatment of OSAS. The treatment pressure can be reduced significantly, and sleep microstructure improved with APAP(FOT). These might be the reasons for patient preference of automatic therapy.