The value of auto-adjustable CPAP devices in pressure titration and treatment of patients with obstructive sleep apnea syndrome

SUMMARY 

In moderate to severe obstructive sleep apnea syndrome (OSAS), the use of Continuous Positive Airway Pressure (CPAP) is the gold standard therapy. In the last decade, new technologies such as auto-adjustable CPAP (APAP) have been promoted as having an added advantage over CPAP, because of their ability to adapt the pressure level to the patient's need at all times. This could logically result in the deliverance of lower pressures, which was hypothesized to improve patient acceptance and compliance for therapy.

Several clinical trials have been performed with APAP in different modalities, as a titration tool in attended or unattended conditions, or as a treatment device for chronic use. Comparison of these trials is challenging, since APAP technology is evolving promptly and devices differ not only in how sleep-disordered breathing is detected, but also in how the operational algorithm responds accordingly. Although the question remains whether proof has yet been delivered of the superiority of this technology over CPAP, there is a tendency to accept it as common standard practice in OSAS titration and treatment. This review will bring available evidence on this subject into perspective.

Keywords: Obstructive sleep apnea, OSAS, Continuous positive airway pressure, Automatic CPAP, Auto-adjustable CPAP, APAP, Snoring, Prediction formula, Sleep-disordered breathing

Abbreviations: AHI, apnea-hypopnea index, APAP, automatic/auto-adjustable CPAP, CPAP, continuous positive airway pressure, FPAP, fixed CPAP pressure, OSAS, obstructive sleep apnea syndrome, P_pred, predicted CPAP pressure, P₉₅, 95th percentile, pressure which is not exceeded during 95% of the time, PSG, polysomnography, REM sleep, rapid eye movement sleep