Two sleep reports support auto-CPAP

Sunday, February 6, 2005

February 14, 2005

YARMOUTH, Maine – Two recent studies on auto-adjusted CPAP offer conclusions on clinical efficacy and compliance rates that home sleep providers may find encouraging.
First, a European multi-center study on “Alternative Methods of Titrating CPAPs” found unattended home-based auto-adjusted CPAP titration to be a suitable alternative to full polysomnography. The other study, conducted by Kirk G. Watkins, MD, determined that use of the ResMed AutoSet automatic positive airway pressure (APAP) device improves patient compliance in the treatment of obstructive sleep apnea.
While Poway, Calif.-based ResMed wasn’t directly involved in either study, product manager Simon Johnson observed that the results continue to validate the clinical efficacy of auto-titration and alternate site sleep therapy.
The European study, conducted in Madrid, Spain, included 360 patients with sleep disordered breathing that were divided into three groups: standard, auto-adjusted and predicted formula titration with domiciliary adjustment. The follow-up period was 12 weeks.
“With CPAP treatment, the improvement in subjective sleepiness and apnea-hypopnea index as very similar in three groups,” the study reported. “There were no differences in the objective compliance of CPAP treatment and in the dropout rate at the end of follow-up. Auto-adjusted titration at home and predicted formula titration with domiciliary adjustment can replace standard titration. These procedures could lead to considerable savings in cost and to significant reductions in the waiting list.”
Though promising, Johnson cautioned that the Madrid results should not be construed as advocating remote site therapy over institutional polysomnography.
“It’s not appropriate to say that a device like the AutoSet should replace the sleep lab, but instead that it serves well as an adjunct while the patient waits to get into the sleep lab,” Johnson said. “Because the sleep lab waiting list can be up to two years, papers like this suggest that the AutoSet may serve as a temporary triage until the patient can get into the lab.”
Watkins, of St. George (Utah) Sleep Medicine Center, measured patient compliance rates associated with the ResMed AutoSet and found that 76% of 122 sleep apnea patients studied showed compliance with APAP at one year. By contrast, other studies have determined CPAP compliance to be less than 50%.
“The use of the APAP device results in higher rates of patient compliance for positive airway pressure therapy when compared to previously reported compliance rates using fixed-pressure positive airway pressure,” Watkins concluded. “The AutoSet algorithm together with patient educational support enhances compliance in patients with OSA.”