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Clinical Investigations: SLEEP AND BREATHING |

Constant vs Automatic Continuous Positive Airway Pressure Therapy*: Home Evaluation

Marie-Pia d’Ortho, MD, PhD; Véronique Grillier-Lanoir, MD; Patrick Levy, MD, PhD; Françoise Goldenberg, MD; Evelyne Corriger, RT; Alain Harf, MD, PhD; Frédéric Lofaso, MD, PhD
Author and Funding Information

*From the Service de Physiologie-Explorations Fonctionnelles and Institut de la Santé et de la Recherche Médicale (INSERM) U492 (Drs. d’Ortho, Goldenberg, and Harf), Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil; Service d’Explorations Fonctionnelles (Dr. Lofaso), Hôpital Raymond Poincaré, Assistance Publique-Hôpitaux de Paris, Garches; Département de Pneumologie-Laboratoire de Sommeil and UMR CNRS 5525 (Dr. Levy), CHU de Grenoble, Grenoble; Société Nellcor-Puritan Bennet (Dr. Grillier-Lanoir), Villers-lès-Nancy; and ADEP Assistance (Ms. Corriger), Rue Voltaire, Suresnes, France.

Correspondence to: Marie-Pia d’Ortho, MD, Service de Physiologie-Explorations Fonctionnelles, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France; e-mail: dortho@im3.inserm.fr



Chest. 2000;118(4):1010-1017. doi:10.1378/chest.118.4.1010
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Study objectives: To compare the efficacy and patient tolerance, compliance, and preference between auto-continuous positive airway pressure (CPAP) and constant CPAP.

Design: Single-blinded, crossover, cohort study of consecutive patients with obstructive sleep apnea syndrome, with two treatment periods of 2 months each.

Patients: Twenty-five patients (22 men, 3 women) with sleep apnea syndrome confirmed by ambulatory polysomnography.

Measurements and interventions: After baseline polysomnography, patients underwent in-laboratory polysomnography for titration of constant CPAP. The order of treatment was randomly allocated, either auto-CPAP and then constant CPAP, or vice versa. The auto-CPAP pressure range was 6 to 16 cm H2O. At the end of each 2-month period, patients underwent a control ambulatory polysomnography and received a questionnaire on subjective well-being and device evaluation. Duration of use was checked through CPAP device monitoring.

Results: No differences were found in apnea/hypopnea index (constant CPAP, 9.7 ± 1.9 events/h vs auto-CPAP, 10.6 ± 9.3 events/h), awakening/arousal index (constant CPAP, 13.7 ± 8.0 events/h vs auto-CPAP, 15.5 ± 8.9 events/h), slow-wave sleep duration, nocturnal saturation, or complaint of daytime sleepiness. The mean pressure required was significantly lower during auto-CPAP than during constant CPAP (8.8 ± 1.8 cm H2O vs 9.7 ± 2.6 cm H2O, respectively). Patient tolerance, compliance, and duration of use were similar with both treatments.

Conclusions: Auto-CPAP is as effective as constant CPAP. A wide pressure range for auto-CPAP can be used in all patients, suggesting that, in the future, use of a broad pressure range in the auto-CPAP mode could obviate the need for the titration night.

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