Published ahead of print on November 24, 2004, doi:10.1164/rccm.200401-019OC Am. J. Respir. Crit. Care Med., Volume 171, Number 5, March 2005, 500-505 A more recent version of this article appeared on March 1, 2005
Submitted on January 9, 2004 Arbitrary-pressure Continuous Positive Airway Pressure for Obstructive Sleep Apnea SyndromeCraig A Hukins1*1 Department of Respiratory and Sleep Medicine, Sleep Disorders Centre, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia * To whom correspondence should be addressed. E-mail: craig_hukins{at}health.qld.gov.au.
Current resources are inadequate to meet the demand for polysomnography resulting in long waiting lists. This study aimed to evaluate the role of arbitrary-pressure continuous positive airway pressure as a method to reduce delays in commencing treatment. The study was an open, randomized, parallel design. Ninety-one subjects with obstructive sleep apnea syndrome were randomized to either arbitrary-pressure continuous positive airway pressure based on Body Mass Index before treatment polysomnography or to continuous positive airway pressure at settings determined by polysomnography. Both interventions resulted in similar improvements in clinical outcomes of Epworth Sleepiness Score, Quality of Life (Short Form 36), objective compliance and subjective attitudes to treatment. There was higher sleep efficiency at treatment polysomnography in the group commenced at arbitrary pressure (81.8±10.1% (mean±SD) compared to 72.2±18.0%, p=0.01). Subjects unable to tolerate continuous positive airway pressure were identified with the use of arbitrary pressure, leading to a reduction in the proportion of wasted treatment polysomnograms (studies performed in subjects not persisting with treatment) relative to commencing therapy after treatment polysomnography (3/39 compared to 12/35, p=0.01). This approach to initiating treatment with continuous positive airway pressure appears feasible where there are long waiting lists for polysomnography. Key words: obstructive sleep apnea, CPAP, arbitrary pressure
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