HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:
Guest Access | Sign In via User Name/Password

This Article Full Text Free Full Text (PDF) Free Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to My Personal Article Archive Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (5) Citing Articles via Google Scholar Google Scholar Articles by Nilius, G. Articles by Ruhle, K.-H. Search for Related Content PubMed PubMed Citation Articles by Nilius, G. Articles by Ruhle, K.-H.

Pressure-Relief Continuous Positive Airway Pressure vs Constant Continuous Positive Airway Pressure^*

A Comparison of Efficacy and Compliance

^* From the Pneumology Department, Klinik Ambrock, Hagen, Germany.

Correspondence to: Georg Nilius, MD, Klinik Ambrock, Ambrocker Weg 60 58091, Hagen, Germany; e-mail: nilius{at}klinik-ambrock.de

Abstract

Objectives: To compare polysomnographic data and compliance in sleep apnea patients receiving continuous positive airway pressure (CPAP) and pressure-relief CPAP (PRCPAP) [C-flex; Respironics; Murrysville, PA] as first treatment in the sleep laboratory and subsequently at home.

Design: A prospective, randomized, crossover design was used in the sleep laboratory, and a prospective randomized design was used at home.

Patients: Data were collected from 52 sleep apnea patients for whom CPAP was used for the first time.

Interventions: Treatment with constant CPAP and PRCPAP.

Measurements and results: Patients with a first-time diagnosis of obstructive sleep apnea syndrome (OSAS) underwent conventional CPAP titration. Thereafter, polysomnography was performed at the titrated pressure using both the fixed CPAP pressure mode and the PRCPAP mode in a randomized crossover approach. The patients were then discharged home for 7 weeks of treatment with the last-applied treatment mode, and compliance data were established at the end of that time. The average apnea-hypopnea index was 53.3/h in the "diagnostic night," 5.8/h with CPAP, and 7.0/h with PRCPAP. The native arousal index was 35.2/h, 12.6/h with CPAP, and 12.9/h with PRCPAP (not significant [NS]). The central apnea index was 0.7/h with CPAP and 1.2/h with PRCPAP (p < 0.05). Compliance after 7 weeks was, on average, 9.4 min longer with PRCPAP than with CPAP (NS). Evaluation of a 13-item questionnaire showed scores of 16.4 for PRCPAP and 18.1 for constant CPAP (NS) [the fewer the complaints, the lower the score]. With regard to oral dryness, the score with PRCPAP (1.4) was significantly lower than with constant CPAP (1.9) [p < 0.05]. This difference was no longer detectable after 7 weeks.

Conclusion: In terms of the effectiveness in treating obstructive sleep apnea, PRCPAP and constant CPAP are comparable. During the first night of treatment, patients receiving PRCPAP had less dryness of mouth; over a period of 7 weeks, this difference disappeared. Nightly use of the device was comparable in both groups. PRCPAP is therefore a new ventilation mode that enables effective treatment of OSAS patients. Further studies should be done to investigate the effects of expiratory pressure lowering in low-compliance patients and patients requiring CPAP > 9 cm H₂O or experiencing dry mouth with CPAP.

Key Words: compliance • continuous positive airway pressure • obstructive sleep apnea • pressure relief continuous positive airway pressure

This article has been cited by other articles:

				A. Ozsancak, C. D'Ambrosio, and N. S. Hill Nocturnal Noninvasive Ventilation Chest, May 1, 2008; 133(5): 1275 - 1286. [Abstract] [Full Text] [PDF]