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* From the Clinic Ambrock, Clinic for Pneumology, Allergology and Sleep Medicine (Drs. Randerath, Feldmeyer, Rühle, and Ms. Parys), Hagen, Germany; and the Department of Medicine I (Dr. Sanner), Ruhr University Bochum, Marienhospital, Herne, Germany.
Correspondence to: Winfried J. Randerath, MD, Klinik Ambrock, Klink für Pneumologie, Allergologie und Schlafmedizin, Ambrocker Weg 60, D-58091 Hagen, Germany
Study objective: Automatic titration using the forced oscillation technique (FOT) has recently been developed for the treatment of obstructive sleep apnea syndrome (OSAS). So far, it is not known if therapy with automatic nasal continuous positive airway pressure (nCPAP) using a preset upper pressure limitation or a free range (which might lead to higher mean pressure) is preferable with regard to obstructive events, sleep stages, and pressure characteristics.
Design: After diagnostic polysomnography, patients were randomly assigned to two settings with the self-adjusting nCPAP (APAP) device based on the FOT. In mode 1, the pressure variation ranged from 4 to 15.5 cm H2O, and in mode 2, the pressure variation ranged from 4 cm H2O to an individual upper pressure limit.
Patients: Eleven men, aged 53.0 ± 6.8 years with a body mass index of 32.4 ± 5.1 kg/m2 and an apnea-hypopnea index (AHI) of 31.6 ± 26.6/h.
Measurements and results: Manually titrated pressure was at 9.3 ± 2.1 cm H2O, the mean pressure in mode 1 was 5.4 ± 1.0 cm H2O (p < 0.01), and the mean pressure in mode 2 was 5.1 ± 0.7 cm H2O (p < 0.01). A reduction of respiratory events (baseline AHI, 31.6 ± 26.6/h; AHI in mode 1, 3.4 ± 4.5; AHI in mode 2, 5.0 ± 7.2; each with p < 0.001) and an increase in the "rapid eye movement" stage of sleep (baseline, 13.0 ± 5.5%; mode 1, 22.0 ± 7.7 [p < 0.05]; mode 2, 23.0 ± 7.9 [p < 0.01]) were achieved. In mode 1, the mean pressure was below the manual pressure 91.7 ± 9.3% of the time, and in mode 2, the mean pressure was below the manual pressure 90.4 ± 6.3% of the time. The manual pressure was exceeded by 5.5 ± 7.4% (mode 1) and by 5.2 ± 3.1% (mode 2).
Conclusion: We conclude that nCPAP therapy based on the FOT permits the adequate treatment of OSAS with significantly lower pressure than manually titrated nCPAP therapy does. A presetting of an upper pressure limit has no advantage compared to free range.
Key Words: auto-adjust • forced oscillation technique • nCPAP therapy • sleep apnea syndrome
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