Source: Annual Congress 2002 - Auto-CPAP in sleep apnoea: clinical aspects
Disease area: Sleep and breathing disorders

Abstract

Automatic CPAP devices (APAP) have been developed to adjust the pressure at a minimum level to avoid the airway collapse in sleep apnea patients (OSA), but differences in working algorithms are observed. To study the efficacy of APAP for titration in a Sleep Unit, in order to be used as unattended home titration, 56 consecutive patients with OSA, apnea-hypopnea index (AHI)>=15, were included. Patients underwent CPAP titration by Virtuosoâ(Respironics USA), an automatic device that senses pharyngeal wall vibrations associated with snoring (precursors to airway obstruction). The pressure ranged 4-15 cmH20. A satisfactory study was achieved when AHI<5, the mean SaO2 exceeded 90% and there was an improvement of sleep architecture. Patients were divided according to titration (group A: satisfactory study, group B:unsatisfactory). Student t and χ2 tests were done when applicable. Group A included 43 patients (77%) and group B 13 patients (23%). No differences were observed between both in age (54±]9 v 58±] 15),BMI(33±]5 v 34±]5), but in baseline AHI (31±]16 v 44 ±] 20, p=0.02),arousal index (18±]12 v 24±]17, p=0.02) and mean SaO2 (91±]2 v 88±]4, p=0.005), without differences in sleep efficiency and stages, baseline and minimal SaO2. All variables were normalized in group A after APAP (mean pressure <90% of time=7.3 ±]1.8). In group B the mean AHI during APAP was 16 ±] 14 without significant changes in non-REM sleep and sleep efficiency. In 6 patients (46%) there was no activation of APAP and the raised pressure was insufficient in the remaining (54%). Failures on APAP were attributed not only to OSA severity but also to the snoring pattern. We conclude that APAP based in pharyngeal wall vibrations may not be fully effective and manual titration would be necessary for almost one third of patients.

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J. Signes-Costa, E. Chiner, J. M. Arriero, E. Gomez-merino, A. Andreu, J. Marco (Benidorm, San Juan de Alicante, San Sebastian, Sant Cugat des Valles, Spain). Efficacy of an automatic positive airway pressure system for treatment of obstructive sleep apnoea. Eur Respir J 2002; 20: Suppl. 38, 174

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