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Sleep disordered breathing
Continuous positive airway pressure titration for obstructive sleep apnoea: automatic versus manual titration
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  1. Nigel McArdle1,
  2. Bhajan Singh2,
  3. Michelle Murphy2,
  4. Kevin R Gain1,
  5. Christine Maguire2,
  6. Sarah Mutch2,
  7. David R Hillman2
  1. 1University of Western Australia, School of Medicine and Pharmacology, Respiratory Medicine Department, Royal Perth Hospital, Western Australia
  2. 2Sir Charles Gairdner Hospital: Western Australian Sleep Disorders Research Institute, Department of Pulmonary Physiology, Perth, Western Australia
  1. Correspondence to Dr Nigel McArdle, University of Western Australia, School of Medicine and Pharmacology, Respiratory Medicine Department, Royal Perth Hospital, Perth 6000, Western Australia; nmcardle{at}cyllene.uwa.edu

Abstract

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 ≥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.

Australian New Zealand Clinical Trials Registry Number ACTRN12608000054314.

  • Automatic positive airway pressure
  • nasal continuous positive airway pressure
  • obstructive sleep apnoea syndrome
  • cost-effectiveness
  • sleep apnoea

https://doi.org/10.1136/thx.2009.116756

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    Footnotes

    • Funding ResMed Ltd, Australia. The funding source played no role in the study design, the analysis or interpretation of data or the decision to submit the manuscript for publication.

    • Competing interests DRH has served as a consultant to ResMed Ltd, Inspiration medical and Apnex medical. NMc received $AU54 000 In 2005 and 2006 from ResMed Ltd as a grant to help fund the current study.

    • Ethics approval This study was conducted with the approval of the ethics committee of the Sir Charles Gairdner Hospital, Perth, Australia.

    • Provenance and peer review Not commissioned; externally peer reviewed.