Computerized adjustable versus fixed NCPAP treatment of obstructive sleep apnea

Abstract

An automated positive airway pressure device that monitors respiratory patterns and provides dynamic, real-time, relational pressure has been developed for the treatment of obstructive sleep apnea (OSA). The purpose of this study was to compare self adjusting pressure to classical nasal continuous positive airway pressure (NCPAP). Subjects were newly diagnosed patients with a minimum respiratory disturbance index (RDI) of 15 episodes per hour who had undergone NCPAP titration and been using classical NCPAP at home on a nightly basis for at least 2 weeks. Patients then underwent repeat standard polysomnographic (PSG) evaluations for 2 nights using a selfadjusting pressure mode and a standard NCPAP mode randomly assigned in a single-blind crossover fashion. Eight males and four females (n = 12), aged 48.4 ± 12.2 years [mean ± and standard deviation (SD)], completed the study. During initial diagnostic PSG, the RDI was 57.3 ± 30.8 episodes per hour. The RDI and minimum oxygen saturation for both treatment nights were significantly improved from those of the diagnostic PSGs (p < 0.001). The subjects spent 63.1 ± 34.2% of total sleep time below prescribed pressure while on automatic pressure. Percent of total sleep time in stage 3/4 sleep was significantly higher during self-adjusting pressure, at 8.6 ± 7.5%, compared to standard NCPAP, at 4.6 ± 6.0% (p < 0.05). Computerized adjustable nasal positive airway pressure effectively controls OSA, fluidly providing the minimal pressure necessary to control respiratory events without causing sleep disruption.