Comparison of three ways to determine and deliver pressure during nasal CPAP therapy for obstructive sleep apnoea

Sophie D West ^1*, David R Jones ¹ and John Stradling ¹

¹ Oxford Centre for Respiratory Medicine, United Kingdom

^* To whom correspondence should be addressed. E-mail: sophie{at}west66.freeserve.co.uk.

Accepted 4 October 2005

Abstract

Background: The simplest method of initiating and maintaining therapeutic continuous positive airways pressure (CPAP) therapy for obstructive sleep apnoea (OSA) is not established.

Methods: 98 people with OSA, requiring CPAP treatment (>10, >4% oxygen desaturation dips/hour of sleep study, and Epworth Sleepiness Score (ESS) >9) were randomized prospectively to three different methods of CPAP delivery for 6 months (Autoset Spirit, ResMed): A) autotitrating pressure throughout; B) autotitrating pressure for 1 week, followed by fixed pressure (95th centile) thereafter; and C) fixed pressure, determined by algorithm (based on neck size and dip rate). Patients and investigators were blind to group allocation. CPAP therapy was initiated mostly at home, following afternoon clinic training and induction. One week after initiation, the sleep nurses reviewed all patients routinely. Study assessments took place before CPAP therapy, at 1 and 6 months after, to assess ESS, maintenance of wakefulness test, 24-hour blood pressure, general health (SF-36) and sleep apnoea related quality of life (SAQLI). CPAP internal monitoring data were also collected.

Results: There were no significant differences in any of the outcome measures or CPAP monitoring data between the three groups. The 95th centile CPAP pressures delivered in the 6-month autotitration and the 1-week autotitration groups were higher than in the algorithm group, but the median pressures were lowest in the 6-month autotitration group.

Conclusions: The method of determining CPAP pressure for moderate to severe OSA treatment makes no significant difference to clinical outcome measures. This particular autotitrating CPAP machine shows no advantage in this setting over simpler methods of pressure determination.

Keywords: algorithm, outcomes, polysomnography, treatment

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