Abstract
Obstructive sleep apnoea (OSA) is often treated with autotitrating continuous positive airway pressure (autoCPAP) devices. Clinical and bench tests of these devices have suggested performance limitations. These studies do not indicate whether this is a failure to detect or a failure to respond to airway obstruction.
In this randomised, crossover trial, 34 patients with moderate-to-severe OSA underwent polysomnography on two laboratory visits. The autoCPAP device was randomly set to a fixed subtherapeutic pressure (detection assessment) or autotitrating mode (response assessment). Airflow was measured both from the autoCPAP (autoCPAP flow) and directly from the nasal mask, and recorded on polysomnography. Apnoea/hypopnoea indices (AHIs) measured at the two sites and from the autoCPAP download report were compared.
Regarding detection, the AHI measured from the nasal mask showed good agreement with the autoCPAP flow AHI, but agreement was lower with the autoCPAP report AHI. In autotitrating mode, there was significant misclassification of those with and without OSA (AHI ≥10 events·h−1) on the autoCPAP report. Regarding response, residual OSA (AHI ≥10 events·h−1) was still evident in 24% of patients during autotitration.
In some patients, autoCPAP fails to detect and/or respond to sleep apnoea. Clinicians should consider limitations of each device and use caution when using autoCPAP report statistics to verify effective treatment.
- Autotitrating continuous positive airway pressure
- continuous positive airway pressure
- obstructive sleep apnoea
- residual sleep apnoea
Footnotes
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Clinical Trial
This study is registered in the Australian and New Zealand Clinical Trials Registry with identifier number ACTRN12606000486527.
Support Statement
This study was supported by an AusIndustry Biotechnology Innovation Fund Grant.
Statement of Interest
Statements of interest for G.C. Dungan II, N.S. Marshall and R.R. Grunstein can be found at www.erj.ersjournals.com/site/misc/statements.xhtml
- Received June 2, 2011.
- Accepted September 26, 2011.
- ©ERS 2012