Effectiveness of Auto-CPAP versus Fixed-CPAP for the Treatment of Obstructive Sleep Apnea Syndrome: A Meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

XU Ting ,  LI Taoping , XIAN Lewu , LI Dangqing , WANG Yuanyuan

Department of Sleep Disorder Center, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China;

Corresponding?author：

LI Taoping, Email: ltpnet@126.com

Keywords：

Obstructive sleep apnea syndrome; Continuous positive airway pressure; Systematic review; Meta-analysis; Randomized controlled trial

DOI：

10.7507/1672-2531.20110120

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective 　To assess the effectiveness of the auto-continuous positive airway pressure (Auto-CPAP) versus the fixed-continuous positive airway pressure (Fixed-CPAP) in patients with obstructive sleep Apnea syndrome (OSAS).
Methods 　Such databases as PubMed (1990 to 2010), SpringerLink (1995 to 2010), CNKI (1990 to 2010), WanFang Data (1995 to 2010), and Google academic (1994 to 2010) were searched, the relevant conference theses were retrieved, and the experts in this field were enquired to collect the randomized controlled trials (RCTs) on Auto-CPAP versus Fixed-CPAP for patients with OSAS. Two reviewers independently screened the trials according to inclusion and exclusion criteria, abstracted the data, and assessed the methodology quality. Meta-analyes was performed using RevMan 5.0 software.
Results 　A total of 11 RCTs involving 327 patients were included. The results of meta-analyses showed that, compared with the Fixed-CPAP group after treatment, the Auto-CPAP group significantly reduced the mean effective therapeutic pressure (WMD=-1.79, 95%CI -3.39 to -0.20), won much better treatment adherence (WMD=0.43, 95%CI 0.30 to 0.56), but got much higher scores of the Apnea-hypopnea index (AHI) (WMD=1.17, 95%CI 0.25 to 2.08) and Epworth Sleepiness Scale (ESS) (WMD=0.88, 95%CI 0.42 to 1.33) as well. There was no significant difference between those two groups in patients’ subjective preference for treatment (OR=2.06, 95%CI 0.46 to 9.10).
Conclusion 　Compared to the Fixed-CPAP, the Auto-CPAP significantly reduces the mean effective therapeutic pressure and improves the treatment adherence of the patients, but is inferior in decreasing AHI and ESS. However, more high-quality and large-scale RCTs are required to verify the above conclusion because of the limitation of research quality and sample at present.

Citation： XU Ting,LI Taoping,XIAN Lewu,LI Dangqing,WANG Yuanyuan. Effectiveness of Auto-CPAP versus Fixed-CPAP for the Treatment of Obstructive Sleep Apnea Syndrome: A Meta-analysis. Chinese Journal of Evidence-Based Medicine, 2011, 11(6): 687-692. doi: 10.7507/1672-2531.20110120 Copy

1.	1 Young T, Palta M, Dempsey J, et al . The occurrence of sleep-disordered breathing among middle-aged adults. N Engl Med , 1993, 328(17): 1230-1235.
2.	2 Series F, Marc I. Importance of sleep stage-and body position-dependence of sleep apnoea in determining benefits to auto-CPAP therapy. Eur Respir J , 2001, 18(1): 170-175.
3.	3 Teschler H, Berthon-Jones M, Thompson AB, et al . Automated continuous positive airway pressure titration for obstructive sleep apnea syndrome. Am J Respir Crit Care Med , 1996, 154(3): 734-740.
4.	4 Marrone O, Insalaco G, Bonsignore MR, et al . Sleep structure correlates of continuous positive airway pressure variations during application of an autotitrating continuous positive airway pressure machine in patients with obstructive sleep apnea syndrome. Chest , 2002, 121(3): 759-767.
5.	5 Najib TA, Paltel SR, Malhotra A, et al . Auto-titrating versus standard continuous positive airway pressure for the treatment of obstructive sleep apnea: results of a meta-analysis. Sleep , 2004, 27(2): 249-253.
6.	6 Mulgrew AT, Fox N, Ayas NT, et al . Diagnosis and initial management of obstructive sleep apnea without polysomnography. Ann Intern Med , 2007, 146(3): 157-166.
7.	7 Ficker JH, Fuchs FS, Wiest GH, et al . An auto-continuous positive airway pressure device controlled exclusively by the forced oscillation technique. Eur Respir J , 2000, 16(5): 914-920.
8.	8 Ficker JH, Wiest GH, Lehnert G, et al . Evaluation of an auto-CPAP device for treatment of obstructive sleep apnoea. Thorax , 1998, 53(8): 643-648.
9.	9 Mulgrew AT, Cheema R, Fleetham J, et al . Efficacy and patient satisfaction with autoajusting CPAP with variable expiratory pressure vs standard CPAP: a two-night randomized crossover trial. Sleep Breath , 2007, 11(1): 31-37.
10.	10 Nolan GM, Ryan S, O’connor TM, et al . Comparison of three auto-adjusting positive pressure devices in patients with sleep apnoea. Eur Respir J , 2006, 28(1): 159-164.
11.	11 Hertegonne KB, Proot PM, Pauwels RA, et al . Comfort and pressure profiles of two auto-adjustable positive airway pressure devices: a technical report. Respir Med , 2003, 97(8): 903-908.
12.	12 Pevernagie DA, Proot PM, Hertegonne KB, et al . Efficacy of flow-vs impedance-guided autoadjustable continuous positive airway pressure: a randomized cross-over trial. Chest , 2004, 126(1): 25-30.
13.	13 Craig Hukins F. Comparative study of autotitrating and fixed-pressure CPAP in thome: a randomized, single-blind crossover trial. Sleep , 2004, 27(8): 1512-1517.
14.	14 David W, Hudgel MD, Caroline Fung BS, et al . A long-term randomized cross-over comparison of auto-titrating and standard nasal continuous airway pressure. Sleep , 2000, 23(5).
15.	15 Geraldine M, Doherty LS, Mc Nicholas WT, et al . Auto-adjusting vesus fixed positive pressure therapy in mild to moderate obstructive sleep apnoea. Sleep , 2007, 32(2): 189-194.
16.	16 Teschler H, Wessendorf TE, Farhat AA, et al . Two months auto-adjusting versus conventional nCPAP for obstructive sleep apnoea. Eur Respir J , 2000, 15(6): 990-995.
17.	17 Marie-pia D, Grillier-Lanoir V, Levy P, et al . Constant vs automatic continuous positive airway pressure therapy. Chest , 2000, 118(4): 1010-1017.
18.	18 Syed F, Love L, Burt H, et al . A randomized trial of auto-titrating CPAP and fixed CPAP in the treatment Of obstructive sleep apnea-hypopnea. Respir Med , 2004, 98(4): 330-333.
19.	19 Wolfgang G, AnduleIt N, Richter K, et al . Comparison of automatic and continuous positive airway pressure in a night-by-night analysis: a randomized, crossover study. Respir , 2008, 75(2): 163-169.
20.	20 Kin W, Chan WC, Choo KL, et al . A randomized cross-over study of auto-continuous positive airway pressure versue fixed-continuous positive airway pressure in patients with obstructive sleep apnoea. Respir , 2008, 13(1): 79-86.
21.	21 Vincenzo P, Aiolfi S, Costantino G, et al . 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(5): 1393-1399.
22.	22 Fietze I, Glos M, Moebus I, et al . Automatic pressure titration with APAP is as effective as manual titration with CPAP in patients with obstructive sleep apnea. Respir , 2007, 74(3): 279-286.
23.	23 Wonfied J, Schraeder O, Galetke W, et al . Autoadjusting CPAP therapy based on impedance efficacy, compliance and acceptance. Am J Respir Crit Care Med , 2001, 163(3): 652-657.
24.	24 American Thoracic Society. Indications and standards for use of nasal continuous positive airway pressure in sleep apnea syndrome. Am J Respir Crit Care Med , 1994, 150(6): 1738-1745.
25.	26 Meardle N, Oeverevx G, Heidaraejad H, et al . Long- term ues of CPAP therayp for sleep apnea/hypopnea syndrome. Am J Respir Crit Care Med , 1999, 153: 1108-1114.
26.	27 Series F. Is treatment of obstrustive sleep apnea syndrome with auto-NCPAP useful? Sleep , 2000, 23(4): S163-165.
27.	葉寰, 郭兮恒. 阻塞性睡眠呼吸暫停低通氣綜合征患者睡眠過程中呼吸力學的變化. 中華結核和呼吸雜志, 2008, 31(1): 26-31.
28.	夏淑東, 黃席珍. 自動調節持續氣道正壓通氣系統在阻塞性睡呼吸暫停低通氣綜合征診治中的應用. 國外醫學呼吸系統分冊, 2004, 24(4): 210-213.

1. 1 Young T, Palta M, Dempsey J, et al . The occurrence of sleep-disordered breathing among middle-aged adults. N Engl Med , 1993, 328(17): 1230-1235.
2. 2 Series F, Marc I. Importance of sleep stage-and body position-dependence of sleep apnoea in determining benefits to auto-CPAP therapy. Eur Respir J , 2001, 18(1): 170-175.
3. 3 Teschler H, Berthon-Jones M, Thompson AB, et al . Automated continuous positive airway pressure titration for obstructive sleep apnea syndrome. Am J Respir Crit Care Med , 1996, 154(3): 734-740.
4. 4 Marrone O, Insalaco G, Bonsignore MR, et al . Sleep structure correlates of continuous positive airway pressure variations during application of an autotitrating continuous positive airway pressure machine in patients with obstructive sleep apnea syndrome. Chest , 2002, 121(3): 759-767.
5. 5 Najib TA, Paltel SR, Malhotra A, et al . Auto-titrating versus standard continuous positive airway pressure for the treatment of obstructive sleep apnea: results of a meta-analysis. Sleep , 2004, 27(2): 249-253.
6. 6 Mulgrew AT, Fox N, Ayas NT, et al . Diagnosis and initial management of obstructive sleep apnea without polysomnography. Ann Intern Med , 2007, 146(3): 157-166.
7. 7 Ficker JH, Fuchs FS, Wiest GH, et al . An auto-continuous positive airway pressure device controlled exclusively by the forced oscillation technique. Eur Respir J , 2000, 16(5): 914-920.
8. 8 Ficker JH, Wiest GH, Lehnert G, et al . Evaluation of an auto-CPAP device for treatment of obstructive sleep apnoea. Thorax , 1998, 53(8): 643-648.
9. 9 Mulgrew AT, Cheema R, Fleetham J, et al . Efficacy and patient satisfaction with autoajusting CPAP with variable expiratory pressure vs standard CPAP: a two-night randomized crossover trial. Sleep Breath , 2007, 11(1): 31-37.
10. 10 Nolan GM, Ryan S, O’connor TM, et al . Comparison of three auto-adjusting positive pressure devices in patients with sleep apnoea. Eur Respir J , 2006, 28(1): 159-164.
11. 11 Hertegonne KB, Proot PM, Pauwels RA, et al . Comfort and pressure profiles of two auto-adjustable positive airway pressure devices: a technical report. Respir Med , 2003, 97(8): 903-908.
12. 12 Pevernagie DA, Proot PM, Hertegonne KB, et al . Efficacy of flow-vs impedance-guided autoadjustable continuous positive airway pressure: a randomized cross-over trial. Chest , 2004, 126(1): 25-30.
13. 13 Craig Hukins F. Comparative study of autotitrating and fixed-pressure CPAP in thome: a randomized, single-blind crossover trial. Sleep , 2004, 27(8): 1512-1517.
14. 14 David W, Hudgel MD, Caroline Fung BS, et al . A long-term randomized cross-over comparison of auto-titrating and standard nasal continuous airway pressure. Sleep , 2000, 23(5).
15. 15 Geraldine M, Doherty LS, Mc Nicholas WT, et al . Auto-adjusting vesus fixed positive pressure therapy in mild to moderate obstructive sleep apnoea. Sleep , 2007, 32(2): 189-194.
16. 16 Teschler H, Wessendorf TE, Farhat AA, et al . Two months auto-adjusting versus conventional nCPAP for obstructive sleep apnoea. Eur Respir J , 2000, 15(6): 990-995.
17. 17 Marie-pia D, Grillier-Lanoir V, Levy P, et al . Constant vs automatic continuous positive airway pressure therapy. Chest , 2000, 118(4): 1010-1017.
18. 18 Syed F, Love L, Burt H, et al . A randomized trial of auto-titrating CPAP and fixed CPAP in the treatment Of obstructive sleep apnea-hypopnea. Respir Med , 2004, 98(4): 330-333.
19. 19 Wolfgang G, AnduleIt N, Richter K, et al . Comparison of automatic and continuous positive airway pressure in a night-by-night analysis: a randomized, crossover study. Respir , 2008, 75(2): 163-169.
20. 20 Kin W, Chan WC, Choo KL, et al . A randomized cross-over study of auto-continuous positive airway pressure versue fixed-continuous positive airway pressure in patients with obstructive sleep apnoea. Respir , 2008, 13(1): 79-86.
21. 21 Vincenzo P, Aiolfi S, Costantino G, et al . 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(5): 1393-1399.
22. 22 Fietze I, Glos M, Moebus I, et al . Automatic pressure titration with APAP is as effective as manual titration with CPAP in patients with obstructive sleep apnea. Respir , 2007, 74(3): 279-286.
23. 23 Wonfied J, Schraeder O, Galetke W, et al . Autoadjusting CPAP therapy based on impedance efficacy, compliance and acceptance. Am J Respir Crit Care Med , 2001, 163(3): 652-657.
24. 24 American Thoracic Society. Indications and standards for use of nasal continuous positive airway pressure in sleep apnea syndrome. Am J Respir Crit Care Med , 1994, 150(6): 1738-1745.
25. 26 Meardle N, Oeverevx G, Heidaraejad H, et al . Long- term ues of CPAP therayp for sleep apnea/hypopnea syndrome. Am J Respir Crit Care Med , 1999, 153: 1108-1114.
26. 27 Series F. Is treatment of obstrustive sleep apnea syndrome with auto-NCPAP useful? Sleep , 2000, 23(4): S163-165.
27. 葉寰, 郭兮恒. 阻塞性睡眠呼吸暫停低通氣綜合征患者睡眠過程中呼吸力學的變化. 中華結核和呼吸雜志, 2008, 31(1): 26-31.
28. 夏淑東, 黃席珍. 自動調節持續氣道正壓通氣系統在阻塞性睡呼吸暫停低通氣綜合征診治中的應用. 國外醫學呼吸系統分冊, 2004, 24(4): 210-213.

Chinese Journal of Evidence-Based Medicine

Effectiveness of Auto-CPAP versus Fixed-CPAP for the Treatment of Obstructive Sleep Apnea Syndrome: A Meta-analysis

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