The Current Status of Autotitrating Continuous Positive Airway Pressure Systems in the Management of Obstructive Sleep ApneaReport as inadecuate




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Canadian Respiratory Journal - Volume 12 2005, Issue 5, Pages 271-276

Original Article

Department of Public Health Sciences, University of Alberta, Edmonton, Alberta, Canada

Department of Medicine, University of Alberta, Edmonton, Alberta, Canada

Canadian Coordinating Office for Health Technology Assessment, Ottawa, Ontario, Canada



Copyright © 2005 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

BACKGROUND: Autotitrating continuous positive airway pressure APAP devices have the potential to address some of the disadvantages of titration and treatment with conventional continuous positive airway pressure CPAP. Information on the performance of APAP in clinical use is still comparatively limited.

OBJECTIVE: To assess the status of APAP devices in the management of obstructive sleep apnea OSA by reviewing evidence of their efficacy, effectiveness and costs.

METHODS: A systematic search of electronic databases and a review of selected comparative studies on the use of APAP in the diagnosis, titration and treatment of OSA was undertaken. Cost analysis using data applicable to the management of OSA in Edmonton, Alberta was performed.

RESULTS: Thirty-three studies met the selection criteria: three on the use of APAP in diagnosing OSA; six on APAP for titration; 14 that considered short-term treatment outcomes; and 10 that addressed longer-term treatment of OSA. In most studies, patients suffering from cardiac, pulmonary and other medical conditions were excluded. Available data suggested some potential for the use of APAP in the diagnosis of OSA, but further validation is needed. In titration, estimated treatment pressures tended to be lower with APAP than with the manual titration of CPAP. Although lower treatment pressures were achieved with APAP, there was no significant difference in clinical outcome measures between APAP and CPAP. Estimates of costs suggested that APAP may provide savings in some scenarios.

CONCLUSIONS: APAP shows promise in the management of OSA; however, given the exclusion of some categories of patients from trials of this technology, caution is still required in its use.





Author: David Hailey, Philip Jacobs, Irvin Mayers, and Shaila Mensinkai

Source: https://www.hindawi.com/



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