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Auto-titrating versus fixed continuous positive airway pressure for the treatment of obstructive sleep apnea: a systematic review with meta-analyses.

Ip S, D'Ambrosio C, Patel K, Obadan N, Kitsios GD, Chung M, Balk EM - Syst Rev (2012)

Bottom Line: Random effects model meta-analyses were performed for selected outcomes.No study reported on objective clinical outcomes.Statistically significant differences were found but clinical importance is unclear.

View Article: PubMed Central - HTML - PubMed

Affiliation: Institute of Clinical Research and Health Policy Studies, Tufts University School of Medicine, Tufts Medical Center, Boston, MA, USA.

ABSTRACT

Background: Obstructive sleep apnea is a relatively common disorder that can lead to lost productivity and cardiovascular disease. The form of positive airway treatment that should be offered is unclear.

Methods: MEDLINE and the Cochrane Central Trials registry were searched for English language randomized controlled trials comparing auto-titrating positive airway pressure (APAP) with continuous positive airway pressure (CPAP) in adults with obstructive sleep apnea (inception through 9/2010). Six researchers extracted information on study design, potential bias, patient characteristics, interventions and outcomes. Data for each study were extracted by one reviewer and confirmed by another. Random effects model meta-analyses were performed for selected outcomes.

Results: Twenty-four randomized controlled trials met the inclusion criteria. In individual studies, APAP and fixed CPAP resulted in similar changes from baseline in the apnea-hypopnea index, most other sleep study measures and quality of life. By meta-analysis, APAP improved compliance by 11 minutes per night (95% CI, 3 to 19 minutes) and reduced sleepiness as measured by the Epworth Sleepiness Scale by 0.5 points (95% CI, 0.8 to 0.2 point reduction) compared with fixed CPAP. Fixed CPAP improved minimum oxygen saturation by 1.3% more than APAP (95% CI, 0.4 to 2.2%). Studies had relatively short follow-up and generally excluded patients with significant comorbidities. No study reported on objective clinical outcomes.

Conclusions: Statistically significant differences were found but clinical importance is unclear. Because the treatment effects are similar between APAP and CPAP, the therapy of choice may depend on other factors such as patient preference, specific reasons for non-compliance and cost.

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Minimum oxygen saturation (%) with APAP versus fixed CPAP: meta-analysis, with subgroup analyses by minimum AHI threshold. See Figure 2 legend. Note that studies favoring APAP are to the left of the vertical 0 line. Senn A and Senn B were comparisons of two different APAP devices versus fixed CPAP reported in the same study. Base AHI: baseline apnea-hypopnea index (events/hour) in fixed CPAP group; Base min O2: baseline minimum oxygen saturation (%) in fixed CPAP group; fixed: fixed CPAP.
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Figure 6: Minimum oxygen saturation (%) with APAP versus fixed CPAP: meta-analysis, with subgroup analyses by minimum AHI threshold. See Figure 2 legend. Note that studies favoring APAP are to the left of the vertical 0 line. Senn A and Senn B were comparisons of two different APAP devices versus fixed CPAP reported in the same study. Base AHI: baseline apnea-hypopnea index (events/hour) in fixed CPAP group; Base min O2: baseline minimum oxygen saturation (%) in fixed CPAP group; fixed: fixed CPAP.

Mentions: Meta-analysis of nine trials showed a non-significant difference in arousal index of -0.85 events/hour (95% CI, -2.2 to 0.5 events/hour; P = 0.23), favoring APAP (Figure 5) [10,12,14,20,24,26,29,31,32]. Meta-analysis of nine trials showed a statistically significant difference in minimum oxygen saturation of -1.3% (95% CI, -2.2 to -0.4%; P = 0.003), favoring CPAP (Figure 6) [12-14,16,20,24,26,31,32]. Neither meta-analysis had statistically significant heterogeneity. Meta-regression revealed no differences across AHI or study design subgroups.


Auto-titrating versus fixed continuous positive airway pressure for the treatment of obstructive sleep apnea: a systematic review with meta-analyses.

Ip S, D'Ambrosio C, Patel K, Obadan N, Kitsios GD, Chung M, Balk EM - Syst Rev (2012)

Minimum oxygen saturation (%) with APAP versus fixed CPAP: meta-analysis, with subgroup analyses by minimum AHI threshold. See Figure 2 legend. Note that studies favoring APAP are to the left of the vertical 0 line. Senn A and Senn B were comparisons of two different APAP devices versus fixed CPAP reported in the same study. Base AHI: baseline apnea-hypopnea index (events/hour) in fixed CPAP group; Base min O2: baseline minimum oxygen saturation (%) in fixed CPAP group; fixed: fixed CPAP.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3351715&req=5

Figure 6: Minimum oxygen saturation (%) with APAP versus fixed CPAP: meta-analysis, with subgroup analyses by minimum AHI threshold. See Figure 2 legend. Note that studies favoring APAP are to the left of the vertical 0 line. Senn A and Senn B were comparisons of two different APAP devices versus fixed CPAP reported in the same study. Base AHI: baseline apnea-hypopnea index (events/hour) in fixed CPAP group; Base min O2: baseline minimum oxygen saturation (%) in fixed CPAP group; fixed: fixed CPAP.
Mentions: Meta-analysis of nine trials showed a non-significant difference in arousal index of -0.85 events/hour (95% CI, -2.2 to 0.5 events/hour; P = 0.23), favoring APAP (Figure 5) [10,12,14,20,24,26,29,31,32]. Meta-analysis of nine trials showed a statistically significant difference in minimum oxygen saturation of -1.3% (95% CI, -2.2 to -0.4%; P = 0.003), favoring CPAP (Figure 6) [12-14,16,20,24,26,31,32]. Neither meta-analysis had statistically significant heterogeneity. Meta-regression revealed no differences across AHI or study design subgroups.

Bottom Line: Random effects model meta-analyses were performed for selected outcomes.No study reported on objective clinical outcomes.Statistically significant differences were found but clinical importance is unclear.

View Article: PubMed Central - HTML - PubMed

Affiliation: Institute of Clinical Research and Health Policy Studies, Tufts University School of Medicine, Tufts Medical Center, Boston, MA, USA.

ABSTRACT

Background: Obstructive sleep apnea is a relatively common disorder that can lead to lost productivity and cardiovascular disease. The form of positive airway treatment that should be offered is unclear.

Methods: MEDLINE and the Cochrane Central Trials registry were searched for English language randomized controlled trials comparing auto-titrating positive airway pressure (APAP) with continuous positive airway pressure (CPAP) in adults with obstructive sleep apnea (inception through 9/2010). Six researchers extracted information on study design, potential bias, patient characteristics, interventions and outcomes. Data for each study were extracted by one reviewer and confirmed by another. Random effects model meta-analyses were performed for selected outcomes.

Results: Twenty-four randomized controlled trials met the inclusion criteria. In individual studies, APAP and fixed CPAP resulted in similar changes from baseline in the apnea-hypopnea index, most other sleep study measures and quality of life. By meta-analysis, APAP improved compliance by 11 minutes per night (95% CI, 3 to 19 minutes) and reduced sleepiness as measured by the Epworth Sleepiness Scale by 0.5 points (95% CI, 0.8 to 0.2 point reduction) compared with fixed CPAP. Fixed CPAP improved minimum oxygen saturation by 1.3% more than APAP (95% CI, 0.4 to 2.2%). Studies had relatively short follow-up and generally excluded patients with significant comorbidities. No study reported on objective clinical outcomes.

Conclusions: Statistically significant differences were found but clinical importance is unclear. Because the treatment effects are similar between APAP and CPAP, the therapy of choice may depend on other factors such as patient preference, specific reasons for non-compliance and cost.

Show MeSH
Related in: MedlinePlus