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Sleep Breath. 2012 Dec;16(4):1017-26. doi: 10.1007/s11325-011-0626-6. Epub 2011 Dec 3.

Effect of automatic versus fixed continuous positive airway pressure for the treatment of obstructive sleep apnea: an up-to-date meta-analysis.

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1
Department of Sleep Disorder Center, Nanfang Hospital, Southern Medical University, No. 1838 Guangzhou Dadao Bei, Guangzhou, 510515, China.

Abstract

PURPOSE:

This study was made to evaluate the effect of automatic continuous positive airway pressure (auto-CPAP) versus fixed continuous positive airway pressure (fixed CPAP) in reducing the apnea-hypopnea index (AHI) and the mean therapy pressure, improving subjective sleepiness, sleep architecture, patient compliance, and preference in patients with obstructive sleep apnea.

METHODS:

We searched the electronic databases MEDLINE, EMBASE, the Cochrane Library, and Google Scholar. Randomized controlled trials comparing auto-CPAP with fixed CPAP were reviewed. Continuous variables were presented as mean difference (MD), and dichotomous data as odds ratio (OR), both with 95% confidence intervals (CI).

RESULTS:

We identified 19 studies consisting of 845 patients. Compared to fixed CPAP, the use of auto-CPAP reduced mean therapy pressure (MD -1.64; 95% CI -2.46 to -0.82), improved patient compliance (MD 0.23; 95% CI 0.06 to 0.39), increased the percentage of total sleep time (TST) in slow wave sleep (MD 5.11; 95% CI 1.34 to 8.88), and decreased the percentage of TST in stage 2 sleep (MD -4.75; 95% CI -9.38 to -0.11). Moreover, more patients preferred auto-CPAP therapy (OR 3.65; 95% CI 1.27 to 10.53). There were nonsignificant trends towards better outcomes with auto-CPAP for AHI and Epworth Sleepiness Scale (MD -0.43; 95% CI -1.10 to 0.23, and MD -0.24; 95% CI -0.74 to 0.25, respectively), though these are of questionable clinical significance.

CONCLUSIONS:

There are some aspects of clinical care, such as a mild improvement in compliance, patient preference, and sleep architecture that appear to favor the use of auto-CPAP compared to fixed CPAP. The clinical relevance of these findings requires further study.

PMID:
22139138
DOI:
10.1007/s11325-011-0626-6
[Indexed for MEDLINE]
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