Auto-adjusting versus fixed positive pressure therapy in mild to moderate obstructive sleep apnoea.

STUDY OBJECTIVES: To determine if auto-adjusting positive airway pressure (APAP) would be better tolerated on the basis of delivering a lower mean pressure in patients with mild to moderate obstructive sleep apnoea syndrome (OSAS). DESIGN: Patients spent 8 weeks on continuous positive airway pressure (CPAP) and 8 weeks on APAP in a randomized crossover design. SETTING: Respiratory Sleep Disorders Unit in a University Hospital and the patient's home. PARTICIPANTS: Twenty-nine patients with newly diagnosed mild to moderate OSAS (apnoea-hypopnoea frequency of 5-30 events/hour) were studied. INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: Overnight polysomnography and Epworth Sleepiness Scale were recorded at baseline and at the end of each treatment period in addition to patient preference for device, side effects, and objective compliance. No differences were found in polysomnographic variables or Epworth Sleepiness Scale scores between the 2 treatment modes, but all variables were significantly improved from baseline values. Mean APAP pressure levels were significantly lower than CPAP (6.3 +/- 1.4 vs 8.1 +/- 1.7 cm H2O, p < .001). Patient compliance was similar with both treatments. More patients requiring higher fixed pressure (> or = 8cm H2O) preferred APAP, whereas those requiring lower pressure (< 8 cm H2O) preferred CPAP (p = .03). Follow-up after 18 months of therapy indicated that 76% of subjects continued to be compliant, with a nightly use of 5.8 +/- 1.9 hours per night, despite high levels of minor side effects. CONCLUSIONS: APAP and CPAP are equally effective in managing patients with mild to moderate OSAS, but device preference may be influenced by fixed pressure requirements.

Comparison of baroreflex sensitivity measures for assessing subjects with obstructive sleep apnea.

Baroreflex sensitivity (BRS) is assessed in subjects with and without obstructive sleep apnea (OSA) using the time domain direct sequence technique, the spectral transfer function (TF) technique and the alpha index technique. All three measures showed a significantly depressed BRS value in subjects with severe apnea. The high frequency (HF) component of the spectral measures showed higher correlation with the sequence technique measures than the low frequency (LF) component. The baroreceptor effectiveness index (BEI) showed a strong relationship with the HF coherence value from the spectral measures. All three BRS measures decreased with increasing heart rate. Heart rate correction of the sequence technique estimates to 60 beats per minute did not have a significant impact on the BRS estimates.