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Am. J. Respir. Crit. Care Med., Volume 163, Number 3, March 2001, 652-657

Autoadjusting CPAP Therapy Based on Impedance Efficacy, Compliance and Acceptance

WINFRIED J. RANDERATH, OLIVER SCHRAEDER, WOLFGANG GALETKE, FRANK FELDMEYER, and KARL-HEINZ RÜHLE

Klinik Ambrock, Department of Pneumology, Allergology and Sleep Medicine, University Witten/Herdecke, Germany

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 (APAPFOT). We investigated the efficacy and compliance in continuous use at home. Fifty-two patients were treated (randomized crossover) with CPAP and APAPFOT for 6 wk each. Respiratory disturbances, sleep profile, and arousals improved significantly with both modes (AHI: baseline, 35.1 ± 26/h; APAPFOT, 5.0 ± 5.2; CPAP, 4.3 ± 6.3; p < 0.001 baseline versus each mode). The mean pressure with APAPFOT was significantly reduced as compared with CPAP (CPAP, 7.8 ± 1.5 cm H2O; APAPFOT, 5.7 ± 1.8 cm H2O; p < 0.001). Under APAPFOT 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 APAPFOT for home treatment. We conclude that APAPFOT is as efficacious as constant CPAP in the treatment of OSAS. The treatment pressure can be reduced significantly, and sleep microstructure improved with APAPFOT. These might be the reasons for patient preference of automatic therapy.




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