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CPAP better than APAP?
#1
Hello everybody,

Take a look at this: http://journal.publications.chestnet.org...id=1085138

Can anybody tell me what is wrong with this study - did they use an inferior APAP model on purpose, in order to get to perform more titration studies? (I can't find the information regarding what model APAP/CPAP was compared) Or - as I believe - has there been quite a bit of improvement in APAP in the past five years or so... ?
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#2
Johan,

Thank you for posting this link! The study is fascinating but I agree that knowledge of the machines used and how they were set up is critical to truly understand the findings.

On this forum, I've seen many cases where people did not respond well to APAP machines set "wide open," or setting of 4 - 20 cmH2O. In general, narrowing the set point range, based on the patient data, improves therapy.

Again, great study. Hopefully it's another baby step to better treatment for all of us!
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#3
This study is WORTHLESS.

The major issue I have with this study is that it was designed from the start with conditions that will automatically favor constant-pressure CPAP over Auto-CPAP (APAP) in the outcomes. Hardly a truly scientific study, IMHO.

Two points that prove the bias of this study against APAP machines:

1) Please note this statement from the article: "In this study, fixed CPAP was set at the level determined during titration study, while APAP was set so as to deliver pressure levels from 4 to 15 cm H2O." The problem with this is that (as jdireton pointed out), these APAP pressure ranges are nearly "wide-open" - meaning that there is a very wide range of pressures where the machine is allowed to operate (spanning 11 cmH2O altogether). It's quite known that Auto-CPAP is MUCH more effective at reducing AHI when the range of pressures is tightened up closer to something like 2 under and 2-3 over the titrated pressure. (in other words, if the patient's titrated pressure was 10, the best APAP pressure range for most patients would be 8-12 or 8-13). By operating in such a wide-open pressure range of 4-15, the study participants are bound to have less effective treatment from APAP. This is a biased baseline point that they should have accounted for, but did not.

2)
In this study, those who used APAPs were given VERY OLD AUTO-CPAP MACHINES. They state for the auto-CPAP patients, they were using a ResMed AutoSet T, which came out in 2001 for goodness sake! The APAP algorithms and technology has improved dramatically since that machine came out 10 years ago! Please note that this article was written in 2007, and even then, the AutoSet T was older technology.

Again, they seemed to intentionally design the study to come to the conclusion that constant-pressure CPAPs were better, but they can only do that by stacking the deck against APAPs, both in pressure ranges and by using older technology.

Sad attempt... and I almost wonder what agenda they have in doing such a biased study. Dont-know
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#4
Hi JohanKarl, Thanks for posting the link to this "study?"
This makes me wonder if enough proffits weren't being made on the sale of "bricks," so, voila, along comes this study, just a thought.
trish6hundred
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#5
From beginning of article:
"However, no data are available on the effects of APAP on cardiovascular risk factors"
From the end of the article:
"Conclusions: Our results suggest that CPAP and APAP, despite significant effects on OSA indexes and symptoms, do not improve cardiovascular risk factors in the same fashion."
That means everything in between is bad science.
As always, YMMV! You do not have to agree or disagree, I am not a professional so my mental meanderings are simply recollections of things from my own life.

PRS1 - Auto - A-Flex x2 - 12.50 - 20 - Humid x2 - Swift FX
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#6
(09-20-2012, 10:37 AM)mjbearit Wrote: "Conclusions: Our results suggest that CPAP and APAP, despite significant effects on OSA indexes and symptoms, do not improve cardiovascular risk factors in the same fashion."
That means everything in between is bad science.

It sounds to me like the conclusion should be "Fixed CPAP properly set by a skilled clinician in a PSG sleep study and titration usually gives better results than an APAP set at 4-15 cmH2O."

Unfortunately, it didn't compare fixed CPAP to optimal use of an APAP, i.e.

1) APAP set by a skilled clinician to a proper pressure range for the patient based on a PSG sleep test and titration, or

2) APAP set by a skilled clinician to an proper pressure range based on apnea and airflow data collected by an APAP machine during actual home usage over a period of time.

They should also throw in:

3) Manual CPAP with the average doctors, sleep labs, study, DME, insurance, and followup care an apnea patient is going to receive.
Get the free SleepyHead software here.
Useful links.
Click here for information on the main alternative to CPAP.
If it's midnight and a DME tells you it's dark outside, go and check it yourself.
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