[39-Year-Old Woman with Severe COVID-19 Pneumonia: Successful Weaning after Septic Shock and Forefoot Amputation after Microvascular Complications]. / 39-jährige Frau mit schwerer COVID-19-Pneumonie: Erfolgreiches Weaning nach septischem Schock und Vorfußamputation wegen mikrovaskulärer Komplikationen.

We present the case of a slightly obese 39-year-old patient with a severe course of COVID-19 pneumonia. The patient was referred from a hospital to regular care with suspected COVID-19 pneumonia. The initial clinical symptoms consisted of dysuria and fever. A bilateral infiltrate was seen in the chest x-ray. In the CT thorax, advanced COVID-19 typical changes were found on both sides. The COVID-19 infection was confirmed by a positive SARS-CoV-2 PCR from the nasopharynx smear. In the case of progressive ARDS with respiratory exhaustion, the patient was intubated and invasively ventilated. When a bacterial superinfection was suspected, we initiated empirical antibiotic therapy. In addition, a therapy with dexamethasone was applied. Therapy with ASA and weight-adapted semi-therapeutic low molecular weight heparin was also carried out. During the intensive care treatment the patient developed a fulminant septic shock with consecutive severe thrombocytopenia. A dilated tracheotomy was performed. The weaning progress was hampered by recurrent septic attacks. Necrosis in the area of ​​the right foot was identified as the cause of the septic relapses. As there was no alternative focus, surgical rehabilitation with partial amputation was carried out. The patient then remained infection-free and could be weaned from the respirator.

["Nutritional risk screening 2002"--in clinical pneumology]. / "Nutritional Risk Screening 2002" in der Hand des Pneumologen.

Malnutrition is a frequent problem for hospitalized patients. It is a relevant risk factor for morbidity and mortality. The aim of this study was to detect undernutrition and the risk of malnutrition (RM) in patients admitted to a university-affiliated respiratory care clinic. Undernutrition was assessed by body mass index (BMI<18.5 kg/m²) and RM by using the "Nutritional Risk Screening 2002" (NRS 2002) in 705 consecutive patients (BMI: measured in 689 patients/NRS: 680 patients assessed). Data was analysed with regard to age, sex, length of hospital stay as well as underlying pneumological disorders. In 14.3% of 680 patients, RM was detected by NRS. In 2.5% out of 689 patients, undernutrition was identified by BMI. In patients older than 65 years (n=365), these numbers were 19.6% (NRS) and 1.5% (BMI<18.5 kg/m²). Age was a significant risk factor for RM (OR 1.054 per year). Gender, however, was not associated with undernutrition or RM. In a sub-analysis, RM was more frequent in patients with pneumonia and chronic obstructive lung disease (23% and 16%, respectively). Patients with cancer were more frequently at RM as compared to patients with sleep-disordered breathing (OR: 2.33 in cancer, OR: 0.04 in sleep-disordered breathing). RM was associated with a significant increase in length of hospital stay (10.2 ± 9.5 vs. 5.4 ± 6.0 days). Besides the BMI, the NRS provides a valid tool for screening patients at RM.

[Consensus paper on the diagnosis and treatment of sleep disordered breathing]. / Konsensuspapier zur Diagnostik und Therapie schlafbezogener Atmungsstörungen bei Erwachsenen.

Diagnosis and treatment of sleep disordered breathing (SDB) undergo substantial changes, both in terms of increasing scientific knowledge and also in terms of patient provision and socio-economic aspects. Increasing evidence shows the relevance of SDB on morbidity and mortality of affected patients. The precise differentiation of different phenotypes of SDBs has improved substantially in recent years. These proceedings influence the approach to the patients suspected of suffering from SDB. The scientific advances on the one hand are facing intentions to simplify diagnostical processes and treatment initiation and intentions to translate duties of physicians to non-medical personnel on the other hand. This consensus paper presents the principals of diagnosis, treatment initiation and provision, including the role of different participants of the healthcare system, and compares different treatment options. Major aspects include the differentiation of the diagnostical process in screening, affirmation of diagnosis and differential diagnosis. In addition, it focusses on the relevance of the pretest probability and describes a therapeutical algorithm.

[Cerebral microhaemorrhage as imaging correlate of high-altitude cerebral edema in a patient under long-term ventilation]. / Zerebrale Mikroblutungen als bildmorphologisches Korrelat eines High-Altitude Cerebral Edema (HACE) bei einem langzeitbeatmeten Patienten.

Within the scope of a cerebral magnetic resonance imaging to diagnose a dysphagia in a patient on long-term artificial respiration, the morphological criteria for a HACE (high-altitude cerebral edema) have been met. We found microangiopathic white matter lesions in the area of the corpus callosum and splenium, characteristic features of a HACE. HACE is a severe form of altitude sickness with truncal ataxia, disturbance of consciousness through to unconsciousness and coma. The exact pathophysiology is still not known but hypoxia seems to be the triggering stimulus. Thus the question arises: long-term ventilated patients suffering from severe gas exchange disorders develop constellations which are equivalent to HACE?

["Common variable immunodeficiency"--first diagnosis of a rare pneumological disease]. / "Common variable Immunodeficiency" - Eine seltene pneumologische Differenzialdiagnose.

Common variable immunodeficiency (CVID) is generally used synonymously with "late onset hypogammaglobulinaemia", which is already indicative of the central pathological finding. Patients with CVID produce specifically less immunoglobulins, thus reducing their immunological competence. Our patient showed the typical medical history of undetected CVID. After excluding differential pneumological diseases, the suspected diagnosis was confirmed. This case report examines the complex of CVID as a cause for recurrent pneumological infections. It is the most prevalent form of severe antibody deficiency in children and adults and occurs with a probability of 1:25,000 in the population.

[Evaluation of a new automatic CPAP algorithm in the treatment of obstructive sleep apnoea syndrome]. / Evaluation eines neuen Algorithmus zur automatischen CPAP-Therapie beim obstruktiven Schlafapnoe-Syndrom.

BACKGROUND: Automatic continuous positive airway pressure (automatic CPAP, APAP) is an effective treatment option in the obstructive sleep apnoea syndrome (OSAS). The differentiation of obstructive and central respiratory events is crucial in adjusting the optimal pressure in this treatment mode. In this pilot study we evaluated a new automatic CPAP algorithm in OSAS patients. METHODS: 14 patients with newly diagnosed obstructive sleep apnoea syndrome were enrolled. After a diagnostic polysomnography, patients were treated for one night with a new APAP device based on flow, snoring, relative minute volume and the obstructive pressure peak signal. RESULTS: The total apnoea/hypopnoea index (AHI) was 30.0 +/- 21.4/h at baseline and 3.7 +/- 5.3/h with APAP ( P < 0.005). Both obstructive AHI (22.7 +/- 20.5/h at baseline, 1.5 +/- 3.5/h with APAP, P < 0.005) and central AHI (7.3 +/- 4.9/h and 2.2 +/- 2.5/h, respectively, P < 0.01) as well as the arousal index (25.4 +/- 18.1/h and 5.1 +/- 3.8/h, respectively, P < 0.005) were reduced significantly with the new algorithm. CONCLUSIONS: The new algorithm of an automatic CPAP device is effective in the treatment of obstructive sleep apnoea syndrome.

[A questionnaire to capture the functional effects of daytime drowsiness on quality of life in case of obstructive sleep apnea syndrome. Functional Outcomes of Sleep Questionnaire (FOSQ)]. / Ein Fragebogen zur Erfassung der funktionellen Auswirkungen der Tagesschläfrigkeit auf die Lebensqualität beim obstruktiven Schlafapnoe-Syndrom. Functional Outcomes of Sleep Questionnaire (FOSQ).

The Functional Outcome of Sleep Questionnaire (FOSQ) is a questionnaire for capturing the function-specific quality of life (impairment due to daytime drowsiness). It is subdivided into five subscales/sections, each comprising four degrees of severity. So far, no standard values for healthy persons without sleep disorders exist in the German-speaking countries. The aim of our study was therefore first of all to establish standard values for healthy subjects as well as to verify the three quality criteria required for testing procedures (objectivity, reliability, validity). Finally, a comparison between health subjects and OSAS patients was carried out. The study included 210 health subjects and 150 OSAS patients. Regarding standardisation of the FOSQ, the following standard values for healthy persons without sleep disorders were determined for the five subscales: activity 21.4 +/- 2.9; vigilance 20.5 +/- 4.3; intimacy 22.3 +/- 3.9; social QoL 22.6 +/- 3.3; general capability 22.3 +/- 2.7. Age and weight (BMI) influences could be excluded. Concerning verification of the three quality criteria, good values could be established for objectivity, reliability and validity. As a result, significant differences between health subjects and OSAS patients were found. In the five quality of life areas captured (activity 15.8 +/- 4.9; vigilance 14.6 +/- 6.4; intimacy 17.3 +/- 6.5; social QoL 18.9 +/- 5.5; general capability 17.9 +/- 5.2), the patients achieved values distinctly inferior to those of the health probands. In summary, for the German-speaking area, due to its test design, this questionnaire represents a simple procedure for capturing the function-related reduction in quality of life for all age groups both in the clinical field and in case of particular questions relating to expert opinions.

[Pathophysiology of the obesity hypoventilation syndrome]. / Obesitas-Hypoventilationssyndrom--Pathophysiologische Aspekte.

The obesity hypoventilation syndrome (OHS) is defined by extreme overweight (BMI 30 kg/m2), daytime hypoventilation (PaCO2 > 45 mm Hg, the absence of other known causes of hypoventilation) and sleep-related breathing disorders. Obesity impairs breathing due to a restrictive ventilatory disorder, reduction of the capacity of respiratory muscles and diminishment of the ventilatory response. The restriction cannot serve as the only explanation of OHS because body weight or compliance on the one hand and hypoventilation on the other hand only correlate weakly. Obesity increases the work of breathing by greater body mass with its increased oxygen demand, impaired diaphragmatic mobility, upper airway obstruction, and oxygen desaturation which result in an inadequacy of oxygen demand and supply. The adjustment of the chemoreceptors can avoid the overload on the capacity of the respiratory muscles, at least in a number of patients or in the course of the disease. This disproportion results in hypercapnia. Furthermore, the level of leptin is an important factor in the pathophysiology of OHS. The blood level of leptin correlates with the body fat mass in humans. However, there seems to be a relative leptin deficiency in the brain in overweight humans. Therefore, in contrast to animals, leptin cannot sufficiently increase ventilation in man to avoid hypercapnia.

[Comparison of pulmonary compliance and the work of breathing with pulmonary function parameters in men]. / Vergleichende Messungen der Lungen-Compliance und der Atemarbeit mit anderen Lungenfunktionsparametern bei männlichen Probanden.

BACKGROUND: Dynamic and static pulmonary compliance as well as the work of breathing are essential parameters for describing respiratory mechanics. However, current reference values or correlations with other pulmonary function variables have been established only in studies with small numbers of participants. Therefore, the aim of the present study was to compare pulmonary compliance and the work of breathing with different pulmonary function parameters in a large number of men. METHODS: In 208 healthy men, aged 20 to 70 years, spirometry, bodyplethysmography and carbon monoxide transfer factor measurements were conducted. The esophageal pressure method was used to measure dynamic (C (dyn)) and static (C (stat)) compliance. RESULTS: C (dyn) and C (stat) were significantly correlated with total lung capacity (TLC), vital capacity (VC), forced expiratory volume in the first second (FEV (1)) and carbon monoxide transfer factor (T (LCO)). C (dyn) decreased with increasing age, while C (stat) was correlated with height. The elastic and non-elastic work of breathing were significantly correlated with airway resistance, but not with aging. CONCLUSIONS: Lung volumes are important for the interpretation of pulmonary compliance and the work of breathing and therefore have to be considered in the assessment of respiratory mechanics. In contrast, the work of breathing is essentially influenced by the airway resistance. With increasing age there is only a small decrease in pulmonary compliance and the work of breathing.

[Are there alternative therapeutical options other than CPAP in the treatment of the obstructive sleep apnea syndrome]. / Gibt es Alternativen zum nCPAP-Verfahren in der Behandlung des obstruktiven Schlafapnoesyndroms?

Many patients with the obstructive sleep apnea syndrome (OSAS) look for alternative conservative or surgical therapies to avoid to be treated with continuous positive airway pressure. In view of the high prevalence and the relevant impairment of the patients lots of methods are offered which promise definitive cure or relevant improvement of OSAS. The working group "Apnea" in the German Society of Sleep Medicine and Research established a task force to evaluate the scientific literature on non-CPAP therapies in the treatment of OSAS according to the standards of evidence-based medicine. This paper summarizes the results of the task force. The data were unsatisfactorily for most of the methods. Sufficient data were available for intraoral appliances (IOA) and the maxillomandibular osteotomy (MMO). IOA's can reduce mild to moderate respiratory disturbances, MMO are efficient in the short and long term but are performed only in special situations such as craniofacial dysmorphias. Weight reduction and body positioning cannot be recommended as a single treatment of OSAS. Most surgical procedures still lack sufficient data according to the criteria of evidence based medicine. Resections of muscular tissue within the soft palate have to be strictly avoided. But even success following gentle soft palate procedures is difficult to predict and often decreases after years. Results in other anatomical regions seem to be more stable over time. Today combined surgeries in the sense of multi-level surgery concepts are of increasing interest in the secondary treatment after failure of nasal ventilation therapy although more data from prospective controlled studies are needed. There is no evidence for any other treatment options.

Reference values for dynamic and static pulmonary compliance in men.

The aim of the present study was to determine new reference values and predictive variables for dynamic and static pulmonary compliance in men. The investigation was conducted as a prospective study in healthy, non-smoking men with normal pulmonary function parameters including spirometry, bodyplethysmography and CO diffusing capacity. The esophageal pressure method was used to measure dynamic compliance (Cdyn), specific dynamic compliance (Cdyn/ITGV), static compliance (Cstat) and specific static compliance (Cstat/ITGV). Lung recoil pressures were recorded at different levels of total lung capacity (TLC). A total of 208 men aged 20-69 years were included in the study. The mean values for the compliance parameters were: Cdyn: 2.91+/-1.08 L/kPa; Cdyn/ITGV: 0.71 +/- 0.30 kPa (-1); Cstat: 3.34 +/- 1.04 L/kPa; Cstat/ITGV: 0.82 +/- 0.31 kPa (-1). Cdyn, Cdyn/ITGV and Cstat/ITGV were significantly correlated with age and Cstat was related to height, but in multiple regression analyses the predictability for compliance parameters was very low. Lung recoil pressures at all TLC levels significantly decreased with ageing. In conclusion, we demonstrated that the contribution of anthropometric variables to the regression equations of pulmonary compliance was low. With ageing the static pressure-volume curve of the lung shifted to the left without substantial alteration of the slope.

[Variability of the treatment pressure under continuous positive airway pressure treatment in obstructive sleep apnea syndrome]. / Quantifizierung der Druckvariabilität unter kontinuierlicher Positivdruckatmung bei obstruktivem Schlafapnoesyndrom.

BACKGROUND: Selfadjusting CPAP therapy is mostly employed if constant CPAP does not sufficiently suppress respiratory disturbances or is not accepted by the patient. The number of respiratory disturbances and thus the pressure need varies with sleep stages and body position during sleep. However, the analysis of the pressure profile during automatic CPAP therapy indicates a relevant variability of treatment pressure which is independent of the above mentioned criteria. Therefore, we aimed to quantify the pressure variability and its significance in patients with obstructive sleep apnea syndrome (OSAS). METHODS: We analysed the pressure profile during a six-week treatment period with selfadjusting CPAP therapy based on the measurement of the impedance (APAP FOT ). The variability index (VI) was calculated from the deviations of the treatment pressure from the mean pressure. The variability was considered to be low and clinically irrelevant if the VI did not exceed 0.75 as a mean value and in more than 10 % of the nights. PATIENTS: 20 patients (male 19, age 55.5 +/- 10.9 years, BMI 36.6 +/- 26.5 kg/m (2), AHI 36.9 +/- 21.3/h) who were treated with APAP FOT because of intolerance or inefficiency of constant CPAP. RESULTS: The VI was 0.9 +/- 0.7 (range 0.27 +/- 0.05 to 1.95 +/- 0.83). The number of nights with a figure >/= 0.75 reached 17.6 +/- 13.8 (range 0 - 40). In 50 % of the patients the mean VI was lower than 0.75. However, in 7 of these 10 patients the VI exceeded 0.75 in more than 10 % of the nights (4 - 15). Only 3 of 20 patients fulfilled both criteria of pressure stability. The VI showed a significant correlation with P mean (r: 0.66, p < 0.001). CONCLUSIONS: In most patients with difficult-to-treat OSAS a variability of the treatment pressure can be found.

[Importance of routine examinations in patients with obstructive sleep apnea syndrome]. / Bedeutung internistischer Routineuntersuchungen bei Patienten mit obstruktivem Schlafapnoe-Syndrom.

BACKGROUND AND OBJECTIVE: In patients with obstructive sleep apnea syndrome (OSAS) there is an increased comorbidity of internal diseases such as hypertension, coronary heart disease, chronic obstructive pulmonary disease and endocrine diseases. We analyzed prospectively frequency and consequences of pathological results in routine examinations of internal medicine in sleep laboratory. METHODS: 250 patients with OSAS underwent routine bodyplethysmography, blood- gas analysis, electrocardiogram and laboratory studies after anamnesis and clinical examination. Prior to this we indicated, whether we based on history and physical examination deemed any of these examinations necessary. Frequency and kind of pathological results as well as the consequences were analyzed. RESULTS: 129 results of bodyplethysmography and blood-gas analysis were pathological (51.6 % of all investigations), most frequently hypoxemia (22 %) and obstructive pattern (16.4 %). Further steps were necessary in 19 patients (7.6 %); the indication was seen before in 13 patients, therefore 6 results with consequences (2.4 %) were not expected. Laboratory studies were abnormal in 133 patients (53.2 % of all investigations), most of them hyperglycaemia (26.8 %) and elevated liver enzymes (20.4 %). 29 results (11.6 %) had consequences, of which 16 (6.4 %) were not expected. 82 electrocardiograms were pathological (32.8 % of all investigations), presenting most frequently as coronary heart disease (21.2 %). Further steps were necessary in 5 patients (2 %), while that was not expected in 3 patients (1.2 %). CONCLUSIONS: Routine examinations of internal medicine in patients with OSAS frequently present pathological results, which seldom have further consequences. As most of the important results can be predicted by history and clinical investigation, pathological by chance diagnoses are rare. With the exception of blood sugar tests routine examinations for patients with OSAS should be considered critically.

[Spiroergometry in patients with severe chronic obstructive pulmonary disease confined to bed]. / Spiroergometrie bei bettlägerigen Patienten mit schwergradiger COB.

BACKGROUND: Exercise training is recommended for patients with severe chronic obstructive pulmonary disease (COPD) to improve the endurance capacity. While many patients confined to bed are not able to run exercise training, we investigated the influence of a bedside passive-ergometry on ventilation in patients with severe COPD. METHODS: In nine patients with severe COPD confined to bed (FEV1.0 0,94 +/- 0,18 l, IVC 2,3 +/- 0,8 l, Raw 0,91 +/- 0,13 kPa/l/s) we measured oxygen uptake O2, breathing frequency BF and minute ventilation E during rest, passive movement (30 revolutions per minute), additional active movement and maximal exercise. As a control group six healthy men were investigated during rest and passive movement. RESULTS: During maximal exercise in COPD patients O2 peak reached 618 +/- 177 ml/min, BF 26 +/- 7,2/min and E max 24,1 +/- 5 l/min. In rest O2 was 311 +/- 56 ml/min (53 % O2 peak), BF 17,6 +/- 3,1/min and E 13,3 +/- 2,7 ml/min (55 % E max), while during passive movement O2 was increased to 369 +/- 88 (62 % O2 peak), BF to 19 +/- 5,3 and E to 16,4 +/- 4,1 (68 % E max). In contrast O2 in control subjects dropped from 377,5 +/- 38 in rest to 336 +/- 27 ml/min during passive action, BF from 14 +/- 2,1 to 12 +/- 2,4/min and E from 11,1 +/- 1,3 to 9,1 +/- 1 ml/min. CONCLUSIONS: In patients with severe COPD oxygen uptake, breathing frequency and minute ventilation increased not only during active, but even during passive movement of a bedside ergometer. With this method an exercise training is possible even in COPD patients confined to bed.

[Comparison between anterior rhinomanometry and impulse-oscillometric rhinometry found within nasal allergen provocation]. / Vergleich zwischen anteriorer Rhinomanometrie und impulsoszillometrischer Rhinometrie bei nasalen Allergenprovokationen1.

UNLABELLED: Besides the standard method of anterior rhinomanometry (aR), the impulse-oscillometric rhinometry (IOS) is available for measurements of the nasal resistance. The aR is a procedure dependent on the cooperation of the patient, whereas IOS is measured regardless from the breathing activities of the patient. We examined weather the resistance-measurement by means of IOS in comparison to the aR is a more suitable method for nasal allergic provocation. METHOD: 17 patients with anamnestic known rhinokonjunktivitis (6 f, 11 m) had a pricktest and then a nasal provocation testing with an allergen which provoked a reaction on the skin. The complete resistance of the nose was measured in a randomized order by means of aR and IOS. RESULTS: The complete resistance showed neither in the basic measurement (aR 0,38 +/- 0,14 kPa/l/s; IOS 0,38 +/- 0,11 kPa/l/s) nor in the control solution (aR 0,38 +/- 0,14; IOS 0,39 +/- 0,14) nor after application of the allergenic solution (15 min: aR 0,69 +/- 0,27; IOS 0,77 +/- 0,42; 30 min: aR 0,65 +/- 0,29; IOS 0,6 +/- 0,38) a significant difference between the two methods. The results of the measurement of aR and IOS after the allergenic solution showed a positive correlation (15 min: r = 0,63, p < 0,01; 30 min: r = 0,67, p < 0,01). We found by means of clinic and measurement methods in the aR of 7 patients a positive reaction, within 7 patient a negative reaction, 3 patients had a unspecific nasal hyperreactivity. There was a correspondence in 6 of the 7 patients with positive reaction in aR between both methods. 4 of the 7 results with negative reaction in the aR would have been positive then underlying the same criteria in the IOS without announcing the symptomscore a relevant clinical symptomatic while testing. CONCLUSION: IOS is a suitable procedure for nasal provocation testing and provides results similar to the aR. In comparison to aR IOS is not dependent on the patients cooperation. Due to its higher sensitivity the valid limits of the aR at provocation testings cannot be transferred to IOS to avoid a false positive reaction.

Autoadjusting CPAP therapy based on impedance efficacy, compliance and acceptance.

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

Prospective randomized comparison of impedance-controlled auto-continuous positive airway pressure (APAP(FOT)) with constant CPAP.

Background: The measurement of impedance permits reliable detection of obstructive apneas, hypopneas and upper airways resistance syndrome.Objective: To establish whether impedance-controlled self-adjusting positive airway pressure therapy (APAP(FOT)) is equally as good as constant continuous positive airway pressure (CPAP) in the treatment of sleep apnea syndrome (OSAS).Methods: Twenty men and five women with OSAS (age 52.8+/-9.0 years, body mass index (BMI) 31.4+/-5.0 kg/m(2), AHI 32.2+/-18.1/h (mean+/-SD)) underwent baseline polysomnography, manual CPAP titration and two nights of treatment, one with APAP(FOT), one with constant CPAP.Results: With both modes, a significant reduction in respiratory disturbances was seen (apnea/hypopnea index (AHI) baseline 32.2+/-18.1/h, constant CPAP 6.6+/-8.7, APAP(FOT) 5.5+/-3.8/h, P<0.001 baseline vs. each treatment mode). Under APAP(FOT), the sleep profile was normalized (S3/4 baseline 16.3+/-13.9% total sleep time (TST), APAP(FOT) 21.6+/-10.9% TST, P<0.05, rapid eye movement (REM) 14.2+/-6.7% TST vs. 20.3+/-7.3% TST, P<0.01), while with constant CPAP, a tendency towards improvement was found. The mean treatment pressure with APAP(FOT) was significantly lower than the constant CPAP (5.7+/-2.1 vs. 8.3+/-1.6 mbar, P<0.001).Conclusion: We conclude that APAP(FOT) is at least as effective as constant CPAP in normalizing sleep and breathing in OSAS.