CPAP with algorithm-based versus titrated pressure: A randomized study

BackgroundOur goal was to evaluate whether an algorithm-prescribed pressure is effective in sleep apnea–hypopnea syndrome (SAHS) patients requiring continuous positive airway pressure (CPAP).MethodsSAHS patients with an apnea–hypopnea index (AHI) >20/h were selected for a parallel group randomized study including an in-sleep laboratory acute phase and a domiciliary chronic phase. After baseline polysomnography, patients had a second night polysomnography either with CPAP at the algorithm-calculated pressure, followed by home treatment at this pressure without any correction or adjustment (calculation group), or with auto-CPAP titration, followed by home treatment at the pressure judged to be optimal from the auto-titration (titration group). The primary outcome was the change in Epworth sleepiness scale (ESS) at 6 months.ResultsThe calculated pressure (mean (SD)) was 7.0 (1.4) in the calculation group (n = 33), while the optimal pressure was 7.0 (2.2) cmH2O in the titration group (n = 36). During the 6-month treatment at home, the ESS decreased from 8.3 (4.9) to 5.4 (4.0) in the calculation group (n = 20) and from 8.7 (5.4) to 6.4 (5.4) in the titration group (n = 20) (between-group difference not significant).ConclusionIn these SAHS patients with moderate sleepiness treated with CPAP, we found no difference in effectiveness between an algorithm-based pressure and an auto-titrated pressure.