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Published ahead of print on October 4, 2002, doi:10.1164/rccm.200201-022OC

Am. J. Respir. Crit. Care Med., Volume 167, Number 1, January 2003, 20-23

A more recent version of this article appeared on January 1, 2003
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Submitted on January 11, 2002
Accepted on September 23, 2002

Comparison between Automatic and Fixed Positive Airway Pressure Therapy in the Home

Clifford A Massie1*, Nigel McArdle2, Robert W Hart1, Wolfgang W Schmidt-Nowara3, Alan Lankford4, David W Hudgel5, Nancy Gordon6, and Neil J Douglas7

1 Suburban Lung Associates, Elk Grove Village, IL, USA, 2 Department of Medicine, University of Western Australia, Perth, Australia, 3 Sleep Medicine Associates of Texas, Dallas, TX, USA, 4 Sleep Disorders Center of Georgia, Atlanta, GA, USA, 5 Case Western Reserve University, Cleveland, OH, USA, 6 Gordon and Associates, Berkeley, CA, USA, 7 Department of Medicine, Royal Infirmary, Edinburgh, United Kingdom

* To whom correspondence should be addressed. E-mail: clifford.massie{at}sublung.com.

We tested the hypothesis that continuous positive airway pressure (CPAP) use and outcomes can be improved by an auto-titrating CPAP device in patients with obstructive sleep apnea hypopnea syndrome (OSAHS) who require higher (>=10 cm H2O) CPAP pressures. In this multi-site randomized single-blind crossover study, forty-four patients, mean age 49 ± 10 yrs were randomized to six weeks at laboratory-determined fixed pressure and six weeks on auto-titrating CPAP. Average nightly use was greater in automatic mode (306 versus 271 minutes, p=0.005); median and 95th centile pressures in automatic mode were lower (p-values < 0.002). Automatic CPAP resulted in better SF-36 vitality (65 ± 20 versus 58 ± 23, p < 0.05) and mental health scores (80 ± 14 versus 75 ± 18, p < 0.05), but no significant difference in Epworth score (p=0.065). During automatic therapy, patients reported more restful sleep, better quality sleep, less discomfort from pressure, and less trouble getting to sleep for both the first week of therapy and for the averaged scores for weeks 2-6 (all p-values < 0.006). Patients who require higher fixed CPAP pressures use auto-titrating CPAP more and report greater benefit from this therapy.




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