Efficacy and patient satisfaction with autoadjusting CPAP with variable expiratory pressure vs standard CPAP : a two-night randomized crossover trial

• Published in: Sleep & breathing Vol. 11; no. 1; pp. 31 - 37
• Main Authors: MULGREW, A. T, CHEEMA, R, FLEETHAM, J, RYAN, C. F, AYAS, N. T
• Format: Journal Article
• Language: English
• Published: Heidelberg Springer 01-03-2007; Springer Nature B.V; Springer-Verlag
• Subjects: Adult; Biological and medical sciences; Continuous Positive Airway Pressure - instrumentation; Continuous Positive Airway Pressure - methods; Diseases of the respiratory system; Disorders of higher nervous function. Focal brain diseases. Central vestibular syndrome and deafness. Brain stem syndromes; Drug therapy; Equipment Design; Female; Fundamental and applied biological sciences. Psychology; Humans; Male; Medical sciences; Middle Aged; Multiple sclerosis and variants. Guillain barré syndrome and other inflammatory polyneuropathies. Leukoencephalitis; Nervous system (semeiology, syndromes); Neurology; Original; Pain Measurement; Patient Satisfaction; Polysomnography; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Respiratory Mechanics; Self Care - methods; Sleep Apnea, Obstructive - prevention & control; Sleep Apnea, Obstructive - therapy; Sleep. Vigilance; Surveys and Questionnaires; Vertebrates: nervous system and sense organs; Human; Sleep apnea syndrome; Nervous system diseases; CPAP; Night; Respiratory disease; Morning; Satisfaction; Expiration; Sleep disorder; Polysomnography; Pressure relief; Body mass index; Sleep; Treatment; C-Flex; Technology; Auto-CPAP; Sleep wake cycle; Respiration; Neurological disorder; Patient preference
• ISSN: 1520-9512; 1522-1709
• DOI: 10.1007/s11325-006-0078-6

Expiratory pressure relief (C-Flex) technology monitors the patient's airflow during expiration and reduces the pressure in response to the patient. Increased comfort levels associated with C-Flex therapy have potential to improve patient adherence to therapy. The purpose of this study was to assess the combination of autoadjusting CPAP (APAP) and C-Flex in terms of (1) treatment efficacy, and (2) patient preference when compared to standard CPAP. Fifteen patients who had previously undergone formal CPAP titration polysomnography were treated with either one night of the APAP with C-Flex or one night of conventional CPAP, in a crossover trial. Patient satisfaction levels were recorded using visual analog scales (VAS) on the morning after the study. Mean patient age was 50 +/- 12 years, body mass index (BMI) was 36 +/- 6 kg/m(2), baseline AHI was 53 +/- 31 events/h, and CPAP Pressure was 11 +/- 2 cm/H(2)O. APAP with C-Flex was as effective as CPAP, with no differences detected in sleep latency (17 +/- 5 vs 12.3 +/- 3 min, p = 0.4), or respiratory indices (AHI of 4.2 +/- 2 vs 2.4 +/- 0.7 events/h, p = 0.1). VAS scores (scale 0-10) indicated a trend towards increased patient satisfaction while using APAP with C-Flex (7.9 vs 7.2, p = 0.07). 10 patients expressed a preference for APAP with C-Flex (VAS, 0 to 10) over standard CPAP (total positive score of 68, mean score of 4.8 +/- 4.3). One patient expressed no preference. Four patients expressed a preference for CPAP (total positive score of 13, mean score of 0.9 +/- 1.9) (APAP with C-Flex vs standard CPAP, p < 0.01 paired t test). APAP with C-Flex eliminates sleep disordered breathing as effectively as standard CPAP. Patients indicated a preference for APAP with C-Flex suggesting a possible advantage in terms of patient adherence for this mode of treatment.