Document Detail

Continuous positive airway pressure titration for obstructive sleep apnoea: automatic versus manual titration.
MedLine Citation:
PMID:  20627917     Owner:  NLM     Status:  MEDLINE    
BACKGROUND AND AIMS: Manual laboratory continuous positive airway pressure (CPAP) titration for obstructive sleep apnoea (OSA) is costly, time intensive and delays access to treatment. Automatic positive airway pressure (APAP) titration has the potential to reduce cost and improve access to treatment. The aim of this study was to assess the clinical efficacy and costs of APAP titration compared with manual titration in moderate-severe OSA. METHODS: Patients with moderate-severe OSA (apnoea/hypopnoea index >15 and Epworth Sleepiness Score > or = 8) who were free of co-morbidities that could impair APAP titration were eligible. 249 participants were randomised to manual titration, home APAP or laboratory APAP titration to determine a fixed pressure for CPAP. Clinical and direct cost outcomes were assessed after 4 weeks of treatment. RESULTS: Average nightly CPAP use, subjective sleepiness, SF36 quality of life, Trails A and B cognitive function and polysomnographic outcomes were similar among the per-protocol groups. Non-hypertensive patients had a lower resting heart rate (and greater reduction in heart rate) at 4 weeks after laboratory APAP titration compared with home APAP titration. Costs per patient were highest in manual (AU$817.84), followed by laboratory (AU$647.56) and home (AU$132.09) APAP titration. An intention-to-treat analysis confirmed the effectiveness of APAP titration compared with manual titration in the standard clinical setting. CONCLUSIONS: Among patients with moderate-severe OSA without serious co-morbidities, outcomes at 1 month indicate that APAP titration is more cost-effective than manual laboratory titration to determine an appropriate pressure for CPAP for long-term use; with the largest savings occurring in the home APAP patients.
Nigel McArdle; Bhajan Singh; Michelle Murphy; Kevin R Gain; Christine Maguire; Sarah Mutch; David R Hillman
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Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Thorax     Volume:  65     ISSN:  1468-3296     ISO Abbreviation:  Thorax     Publication Date:  2010 Jul 
Date Detail:
Created Date:  2010-07-14     Completed Date:  2010-08-05     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0417353     Medline TA:  Thorax     Country:  England    
Other Details:
Languages:  eng     Pagination:  606-11     Citation Subset:  IM    
University of Western Australia, School of Medicine and Pharmacology, Respiratory Medicine Department, Royal Perth Hospital, Perth 6000, Western Australia.
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MeSH Terms
Blood Pressure / physiology
Continuous Positive Airway Pressure / economics,  methods*
Health Care Costs / statistics & numerical data
Heart Rate / physiology
Middle Aged
Patient Compliance
Severity of Illness Index
Sleep Apnea, Obstructive / economics,  physiopathology,  therapy*
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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