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Randomised controlled trial of auto-adjusting positive airway pressure in morbidly obese patients requiring high therapeutic pressure delivery.
MedLine Citation:
PMID:  20545835     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
Auto-adjusting positive airway pressure (APAP) devices are being increasingly used to treat obstructive sleep apnoea (OSA). Anecdotal encounters of obese patients requiring high therapeutic pressure whose OSA was inadequately controlled by APAP led to this study aiming to compare the effectiveness of continuous positive airway pressure (CPAP) and APAP (S8 Autoset II(®) , ResMed, NSW, Australia) in a randomised, single-blinded crossover trial. Twelve morbidly obese patients with severe OSA [mean ± SD apnoea-hypopnoea index (AHI) 75.8 ± 32.7, body mass index 49.9 ± 5.2 kg m(-2) , mean pressure 16.4 cmH(2) O] were consecutively recruited, and received CPAP or APAP in random order for six nights at home, separated by a four-night washout. Polysomnographic (PSG) indices of OSA were recorded at baseline and following each treatment arm. Both therapies substantially reduced the AHI (APAP 9.8 ± 9.5 and CPAP 7.3 ± 6.6 events h(-1) ; P = 0.35), but residual PSG measures of disease (AHI >5) were common. APAP delivered a significantly lower 95th percentile pressure averaged over the home-use arm than CPAP (14.2 ± 2.7 and 16.1 ± 1.8 cmH(2) O, respectively, P = 0.02). The machine-scored AHI significantly overestimated the level of residual disease compared with the laboratory-scored AHI (using Chicago criteria); however, when the machine-scored AHI was ≤5 and ≤10 this was always confirmed by the PSG data. In morbidly obese OSA patients without significant co-morbid disease requiring high therapeutic pressure, our data provide support for the use of either APAP or manually titrated CPAP. We recommend objective assessment by sleep study if the S8 Autoset II indicates a high level of residual disease.
Authors:
Jessie Bakker; Angela Campbell; Alister Neill
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of sleep research     Volume:  20     ISSN:  1365-2869     ISO Abbreviation:  J Sleep Res     Publication Date:  2011 Mar 
Date Detail:
Created Date:  2011-02-15     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9214441     Medline TA:  J Sleep Res     Country:  England    
Other Details:
Languages:  eng     Pagination:  233-40     Citation Subset:  IM    
Copyright Information:
© 2010 European Sleep Research Society.
Affiliation:
WellSleep Sleep Investigation Centre, Department of Medicine, University of Otago, Wellington, New Zealand.
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