CPAP versus APAP

[IDRIck]

Is there a difference between the two in performance? A recent study says no... See Abstract below:

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 patient preference, specific reasons for non-compliance and cost.

http://www.systematicreviewsjournal.com/content/1/1/20

[zonk]

Is there a difference between the two in performance? A recent study says no...

my autoset is dual machine apap/cpap ... 2 machines in one and cost only few $$ more ... more bang for bucks

I've used my apap in both modes and concluded that apap gives me better therapy
its more important finding the right mask .... the right mask is the key to successful therapy

[Dawei]

Rick--The sleep doc I see has mentioned to me that there is no "medical benefit" of an APAP over a CPAP machine. I understand that to imply that the CPAP is set at the proper pressure for the patient at that point in time.
That being the case, I would ask what happens when the patient's pressure needs change over time? Without repeated sleep studies, how would the pt. or his doc know that now the pt. needs a different pressure and what that pressure is without guessing and trying a different one on the CPAP. By the same token, I ask what about changing pressure needs from one night to the next, or during any one night?
The APAP can deal with those changing pressure needs. So, at a minimum, one could look at an APAP as providing more comfort in that the pt. is not constantly hit with a pressure that is too high at times when that level isn't needed.
From my experience, I've learned that pressure needs definitely do change over time as well as during any one night. The APAP adjusts to those changing needs, and in the process tells me and my doc what those values are. Meanwhile, the CPAP cannot either adapt to those changing pressure needs or keep the pt. and his/her doc informed about what they are!

[Sleepster]

People with higher pressures may prefer APAP's because they allow them to spend more time at lower pressures.

If you have a relatively low pressure and you monitor yourself with a good CPAP machine you may not feel the need for a APAP.

APAP's cost only a little bit more than good CPAP's and can be placed in CPAP mode if desired.

A good CPAP is one that measures the different apnea and hypopnea indices and your leak rate.

[IDRIck]

I posted the abstract and linked the full paper because I thought it was intriguing and thought others may find it interesting as well... I have not visited my sleep doctor but rather was diagnosed as having very severe OSA by him and a report sent to my family physician. The sleep doctor recommended a 15 cm setting with a 2 cm reduction during exhalation which is what the DME supplier used during setup. I can tolerate this pressure very well and my AHI is well under control (99% reduction from my sleep study). I'm satisfied with the current situation and see no need for an APAP (even though my machine can function as an APAP). IMO, we need to be careful not to quickly or lightly suggest someone move from a CPAP to an APAP setup.

[IDRIck]

Rick--The sleep doc I see has mentioned to me that there is no "medical benefit" of an APAP over a CPAP machine. I understand that to imply that the CPAP is set at the proper pressure for the patient at that point in time.
That being the case, I would ask what happens when the patient's pressure needs change over time? Without repeated sleep studies, how would the pt. or his doc know that now the pt. needs a different pressure and what that pressure is without guessing and trying a different one on the CPAP.

Obviously one does no ignore the available data. If AHI gets worse, then certainly something should be done.

By the same token, I ask what about changing pressure needs from one night to the next, or during any one night?

Does it change hourly or every night? My AHI has been below 1 for the last three nights using a set pressure. Will an APAP give better results? I don't see how but I'm an newbie...

The APAP can deal with those changing pressure needs. So, at a minimum, one could look at an APAP as providing more comfort in that the pt. is not constantly hit with a pressure that is too high at times when that level isn't needed.

I'll certainly grant you this point if the pressure causes issues/discomfort for the patient...

From my experience, I've learned that pressure needs definitely do change over time as well as during any one night. The APAP adjusts to those changing needs, and in the process tells me and my doc what those values are. Meanwhile, the CPAP cannot either adapt to those changing pressure needs or keep the pt. and his/her doc informed about what they are!

I've only used a CPAP for 11 nights and certainly am not an expert. My family Doc has tremendous cred with me and he strongly recommended the sleep doctor. I do feel obligated to follow their advice, especially since it has worked very well and I am in the first 30 days of compliance testing...

[oldteddybear]

An APAP can be used to fine tune your pressure that can then be used in a CPAP but not the other way around. My sleep doctor is still trying to fine tune my pressure by occasional visits as I was prescribed a CPAP. This then stopped me from getting an APAP.

Another benefit of an APAP is that your pressure requirements change based on your sleeping position, this allows the machine to lower your pressure when your body is in a position that gravity/pillows are not assisting in closing your airway.

[Dawei]

Rick-- You didn't mention it, but I assume your sleep doc sent his recommend for a CPAP set to 15cm to your regular doctor following the sleep doc seeing results of a sleep study?
Hey, if your AHI stays nice and low like it is now and you don't have mask leak problems (that is, leak is <24L), you're good to go! I don't believe your S9 in auto mode would give any better therapy than what you're getting now when it's in straight CPAP mode. But keep an eye on mask leaks because if too high they will mess up the machine's accuracy in reporting AHI numbers.
Yes, in auto mode, your S9 Autoset does change pressure, as needed, during the night in response to apnea events as they occur.
Acutally, I'm surprised that your doc wrote a Rx for the Autoset right off the bat. I wish more docs were of that mindset, since the Autoset can work as either an auto or straight CPAP.
Best of luck.

[Ugly]

People with higher pressures may prefer APAP's because they allow them to spend more time at lower pressures.

If you have a relatively low pressure and you monitor yourself with a good CPAP machine you may not feel the need for a APAP.

Then again, because my doc didn't see, for whatever reason, a difference in the theoretical pressure during my sleep study and my longstanding pressure setting (since about 2005) I've learned that a borrowed APAP indicates different readings every night. Although I don't have an appointment with him yet, I wrote a letter and included a copy of my sleep log (I have to manually update it every morning) to illustrate what I see over and above a single night sleep study. It is my hope that he'll agree to sign the prescription for an S9 AutoSet because I've been told at the store I can't get one unless the doc feels I would benefit. If it turns out that he refuses then I'll try the average pressure between when I acquired the machine and when I have to take it back to VitalAire (on December 5.)

[IDRIck]

Rick-- You didn't mention it, but I assume your sleep doc sent his recommend for a CPAP set to 15cm to your regular doctor following the sleep doc seeing results of a sleep study?
Hey, if your AHI stays nice and low like it is now and you don't have mask leak problems (that is, leak is <24L), you're good to go! I don't believe your S9 in auto mode would give any better therapy than what you're getting now when it's in straight CPAP mode. But keep an eye on mask leaks because if too high they will mess up the machine's accuracy in reporting AHI numbers.
Yes, in auto mode, your S9 Autoset does change pressure, as needed, during the night in response to apnea events as they occur.
Acutally, I'm surprised that your doc wrote a Rx for the Autoset right off the bat. I wish more docs were of that mindset, since the Autoset can work as either an auto or straight CPAP.
Best of luck.

Correct, the sleep doctor sent the recommended settings to my family doc and he just it on to the DME. I agree, I was surprised that my insurance would cover the S9 Autoset right off the bat! My family doc referred me to the DME which only has S9 Autosets and Respironics System 1's so I knew I would get a good machine that would versatile...

I am interested in trying it as an APAP down the road (sometime after the 30-day compliance test). Best to you.