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SLEEP MEDICINE: Vincenzo Patruno, Stefano Aiolfi, Giorgio Costantino, Rodolfo Murgia, Carlo Selmi, Alberto Malliani, and Nicola Montano Fixed and Autoadjusting Continuous Positive Airway Pressure Treatments Are Not Similar in Reducing Cardiovascular Risk Factors in Patients With Obstructive Sleep Apnea Chest 2007; 131: 1393-1399 [Abstract] [Full text] [PDF]

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Electronic letters published:

Fixed and Auto CPAPs

Dennis E Wulf   (26 January 2008)

Untitled

Nicola Montano, Vincenzo Patruno   (3 February 2008)

Fixed and Auto CPAPs 26 January 2008
Dennis E Wulf, Information Systems Manager Send letter to journal: Re: Fixed and Auto CPAPs wulfman{at}tctwest.net Dennis E Wulf	With regard to: Fixed and Autoadjusting Continuous Positive Airway Pressure Treatments Are Not Similar in Reducing Cardiovascular Risk Factors in Patients With Obstructive Sleep Apnea Chest 2007; 131: 1393-1399 Having read this study and after having been a user of CPAP and APAP machines for the last three years, including spending that amount of time helping users on CPAP forums, I have to conclude that those who designed the study, knew the outcomes in advance (if they knew anything about these machines). In my opinion, the study was "rigged" against the APAP machines to begin with. NOBODY in their right mind and with any knowledge of APAP machines, and especially with regard to a patient's health would configure an Autoadjusting PAP machine with the bottom pressure at 4 cm. These machines need to have the bottom pressure set as close to the patient's titrated pressure as possible.....otherwise, there are too many events that take place before the pressure can get up to where it needs to be.....and in effect, giving substandard therapy. For the BEST results with an APAP, the ideal pressure range ultimately ends up being a very narrow range. Wide open pressure ranges are a recipe for failure. It is also of utmost importance that the patient have access to software that interprets the collected "detailed" data from the machine each night so as to be able to determine how their therapy is progressing.
Untitled 3 February 2008
Nicola Montano, Associate Professor of Internal Medicine University of Milan, Vincenzo Patruno Send letter to journal: Re: this article nicola.montano{at}unimi.it Nicola Montano, et al.	We carefully read Mr Wulf's eLetter concerning our study published on Chest. We would like to point out clearly that any criticism and question are always welcome in the scientific arena, although in the respect of the authors’ scientific conduct. One of the main reasons to employ autoadjusting CPAP in OSA patients, beside of saving the costs of CPAP titration, is to reduce and optimize the mean level of delivery pressure. Indeed, these patients commonly present wide intra-individual differences in the obstructive critical pressure along the night, according to changes in sleep stage and/or body position. Therefore, in selected case, the use of autoadjusting CPAP may improve patients compliance to CPAP treatment. Taking into account this consideration, if we set the bottom pressure of any autoadjusting CPAP very close to upper pressure level, we would surely fail to achieve this target. This is so obvious that it's common in clinical practice to set the autoadjusting CPAP with a quite wide range between lower and upper pressure level. Moreover, we would like to remind Mr Wulf that one of the most quoted study (1) on the clinical use of autoadjusting CPAP was performed with the same device and the same bottom pressure level we used in our study (i.e. 4 cmH2O). The study by Masa et al. was a large multicentric study performed in Spain, involving hundreds of OSA patients and tens of physicians expert in the field of respiratory sleep disorders. Other recent works (2, 3) supported our kind of setting. Even though we highly respect the experience of Mr Wulf with autoadjusting CPAP, we think that the evidence from these studies should represent ours, and also Mr Wulf, only scientific available reference, at least so far. Unless, Mr. Wulf may think that they were performed by unqualified physicians who rigged the studies, did not know the devices they were using and didn't care of their patients’ health, as he suggested in his letter about us.