Randomized Cross-Over Study Comparing Three Models of Auto-Titrating Positive Airway Pressure Therapy for Obstructive Sleep Apnea:

Wish  Banhiran; Sirithorn  Kormongkolkul; Phawin Keskool; Wattanachai  Chotinaiwattarakul; Sarin  Rungmanee

doi:10.33192/smj.v77i4.272529

Authors

Wish Banhiran Department of Otorhinolaryngology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
Sirithorn Kormongkolkul Department of Otorhinolaryngology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
Phawin Keskool Department of Otorhinolaryngology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
Wattanachai Chotinaiwattarakul Division of Neurology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand; Siriraj Sleep Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Sarin Rungmanee Siriraj Sleep Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.

DOI:

https://doi.org/10.33192/smj.v77i4.272529

Keywords:

Auto-titrating positive airway pressure, APAP, obstructive sleep apnea, pressure titration, continuous positive airway pressure, CPAP

Abstract

Objective: To compare pressure, average usage time, residual apnea-hypopnea index (AHI), and patient satisfaction across three models of auto-titrating positive airway pressure (APAP) (A, B, and C refers to APAP devices — APEX, Philips, and Hoffrichter, respectively).

Materials and Methods: Seventy-five adult patients with an AHI of ≥15 events/h who were willing to use APAP were included and randomly assigned to three groups with different APAP sequences generated by computer randomization. After using each model at home for a week, patients returned to the clinic for data collection and switched to the next model. They completed questionnaires regarding their symptoms before and after the therapeutic session.

Results: Data from 62 patients (43 males, 19 females) who completed the research protocol were analyzed. The average 90th–95th percentile pressures for APAP models A, B and C were 7.2 ± 2.2, 9.5 ± 2.6 and 7.4 ± 1.9 cmH2O, respectively (p < 0.001), with an intra-class correlation coefficient (ICC) of 0.52 (95% CI 0.22-0.70). In addition, average usage time and residual AHI differed significantly, with the highest values in model C. However, no significant differences were found in mean pressure or patient satisfaction across the three APAP models.

Conclusion: The 90th–95th percentile pressures, average time usage, and residual AHI varied among APAP models, showing only moderate consistency. These findings suggest that careful consideration is required when selecting an APAP model for home use, as it may affect pressure determination and treatment outcomes.

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