Reliability of home CPAP titration with different automatic CPAP devices

Frédéric Sériès,Julie Plante,Yves Lacasse

doi:10.1186/1465-9921-9-56

Abstract

BackgroundCPAP titration may be completed by automatic apparatus. However, differences in pressure behaviour could interfere with the reliability of pressure recommendations. Our objective was to compare pressure behaviour and effective pressure recommendations between three Automatic CPAP machines (Autoset Spirit, Remstar Auto, GK 420).MethodsSixteen untreated obstructive sleep apnea patients were randomly allocated to one of the 3 tested machines for a one-week home titration trial in a crossover design with a 10 days washout period between trials.ResultsThe median pressure value was significantly lower with machine GK 420 (5.9 +/- 1.8 cm H2O) than with the other devices both after one night and one week of CPAP titration (7.4 +/- 1.3 and 6.6 +/- 1.9 cm H2O). The maximal pressure obtained over the one-week titration was significantly higher with Remstar Auto (12.6 +/- 2.4 cm H2O, Mean +/- SD) than with the two other ones (10.9 +/- 1.0 and 11.0 +/- 2.4 cm H2O). The variance in pressure recommendation significantly differed between the three machines after one night and between Autoset Spirit and the two other machines after 1 week.ConclusionPressure behaviour and pressure recommendation significantly differ between Auto CPAP machines both after one night and one week of home titration.

Highlights

continuous positive airway pressure (CPAP) titration may be completed by automatic apparatus
The aims of the present study were to compare pressure behaviour and Peff recommendations between three different Automatic CPAP machines and evaluate if these parameters are influenced by titration duration
Our results demonstrate that pressure behaviour significantly differs between Auto CPAP machines both after one night and one week of home titration

Summary

Introduction

CPAP titration may be completed by automatic apparatus. differences in pressure behaviour could interfere with the reliability of pressure recommendations. The effective pressure level (Peff) is the one that abolishes obstructive breathing disorders including inspiratory flow limitation and snoring in every sleep stage and body position [13]. It is usually determined during an in-laboratory titration sleep study with continuous acquisition of electrophysiologic variables, instantaneous respiratory flow,. Automatic CPAP devices have been developed that continuously adapt the applied pressure level to the ventilatory profile [14] These devices may be used in two different ways, one is to replace the in-laboratory titration sleep study and determine the Peff level in the patient's usual sleeping environment. The other application of auto CPAP therapy is to replace conventional fixed CPAP therapy at home by a machine that should automatically modify the pressure setting accounting for intra night and night-to-night changes in Peff [17]

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