Skip to main content
SpringerLink
Log in

Effect of automatic versus fixed continuous positive airway pressure for the treatment of obstructive sleep apnea: an up-to-date meta-analysis

  • Review
  • Published:
Sleep and Breathing Aims and scope Submit manuscript

Abstract

Purpose

This study was made to evaluate the effect of automatic continuous positive airway pressure (auto-CPAP) versus fixed continuous positive airway pressure (fixed CPAP) in reducing the apnea–hypopnea index (AHI) and the mean therapy pressure, improving subjective sleepiness, sleep architecture, patient compliance, and preference in patients with obstructive sleep apnea.

Methods

We searched the electronic databases MEDLINE, EMBASE, the Cochrane Library, and Google Scholar. Randomized controlled trials comparing auto-CPAP with fixed CPAP were reviewed. Continuous variables were presented as mean difference (MD), and dichotomous data as odds ratio (OR), both with 95% confidence intervals (CI).

Results

We identified 19 studies consisting of 845 patients. Compared to fixed CPAP, the use of auto-CPAP reduced mean therapy pressure (MD −1.64; 95% CI −2.46 to −0.82), improved patient compliance (MD 0.23; 95% CI 0.06 to 0.39), increased the percentage of total sleep time (TST) in slow wave sleep (MD 5.11; 95% CI 1.34 to 8.88), and decreased the percentage of TST in stage 2 sleep (MD −4.75; 95% CI −9.38 to −0.11). Moreover, more patients preferred auto-CPAP therapy (OR 3.65; 95% CI 1.27 to 10.53). There were nonsignificant trends towards better outcomes with auto-CPAP for AHI and Epworth Sleepiness Scale (MD −0.43; 95% CI −1.10 to 0.23, and MD −0.24; 95% CI −0.74 to 0.25, respectively), though these are of questionable clinical significance.

Conclusions

There are some aspects of clinical care, such as a mild improvement in compliance, patient preference, and sleep architecture that appear to favor the use of auto-CPAP compared to fixed CPAP. The clinical relevance of these findings requires further study.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

Similar content being viewed by others

References

  1. Young T, Peppard PE, Gottlieb DJ (2002) Epidemiology of obstructive sleep apnea: a population health perspective. Am J Respir Crit Care Med 162:1217–1239

    Article  Google Scholar 

  2. Dincer HE, O’Neill W (2006) Deleterious effects of sleep-disordered breathing on the heart and vascular system. Respiration 73:124–130

    Article  PubMed  Google Scholar 

  3. Patel SR, White DP, Malhotra A, Stanchina ML, Ayas NT (2003) Continuous positive airway pressure therapy for treating sleepiness in a diverse population with obstructive sleep apnea: results of a meta-analysis. Arch Intern Med 163:565–571

    Article  PubMed  Google Scholar 

  4. Marin JM, Carrizo SJ, Vicento E, Agusti AG (2005) Long-term cardiovascular outcomes in men with obstructive sleep apnea–hypopnoea with or without treatment with continuous positive airway pressure: an observational study. Lancet 365:1046–1053

    PubMed  Google Scholar 

  5. Engleman HM, Martin SE, Douglas NJ (1994) Compliance with CPAP therapy in patients with the sleep apnoea/hypopnoea syndrome. Thorax 49:263–266

    Article  PubMed  CAS  Google Scholar 

  6. Randerath WJ, Parys K, Feldmeyer F, Sanner B, Ruhle KH (1999) Self-adjusting nasal continuous positive airway pressure therapy based on the measurement of impedance: a comparison of two different maximum pressure levels. Chest 116:991–999

    Article  PubMed  CAS  Google Scholar 

  7. Parish JM, Miller BW, Hentz JG (2008) Autotitration positive airway pressure therapy in patients with obstructive sleep apnea who are intolerant of fixed continuous positive airway pressure. Sleep Breath 12:235–241

    Article  PubMed  Google Scholar 

  8. Morgenthaler TI, Aurora RN, Brown T, Zak R, Alessi C, Boehlecke B, Chesson AL, Friedman L, Kapur V, Maganti R, Owens J, Pancer J, Swick TJ (2008) Practice parameters for the use of autotitrating continuous positive airway pressure devices for titrating pressures and treating adult patients with obstructive sleep apnea syndrome: an update for 2007. An American Academy of Sleep Medicine report. Sleep 31:141–147

    PubMed  Google Scholar 

  9. Ayas NT, Patel SR, Malhotra A, Schulzer M, Jung D, Fleetham J, White DP (2004) Auto-titrating versus standard continuous positive airway pressure for the treatment of obstructive sleep apnea: results of a meta-analysis. Sleep 27:249–253

    PubMed  Google Scholar 

  10. Smith I, Lasserson TJ (2009) Pressure modification for improving usage of continuous positive airway pressure machines in adults with obstructive sleep apnoea. Cochrane Database Syst Rev (4):CD003531

  11. Oremus M, Wolfson C, Perrault A, Demers L, Momoli F, Moride Y (2001) Interrater reliability of the modified Jadad quality scale for systematic reviews of Alzheimer’s disease drug trials. Dement Geriatr Cogn Disore 12:232–236

    Article  CAS  Google Scholar 

  12. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Loannidis JP, Clarke M, Devereaux PJ, Kleijnen J, Moher D (2009) The PRISMA statement for reporting systematic reviews and meta-analysis of studies that evaluate health care interventions: explanation and elaboration. Ann Intern Med 151:W65–94

    PubMed  Google Scholar 

  13. Higgins JP, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analysis. BMJ 327:557–560

    Article  PubMed  Google Scholar 

  14. Vennelle M, White S, Riha RL, Mackay TW, Engleman HM, Douplas NJ (2010) Randomized controlled trial of variable-pressure versus fixed-pressure continuous positive airway pressure (CPAP) treatment for patients with obstructive sleep apnea/hypopnea syndrome (OSAHS). Sleep 33:267–271

    PubMed  Google Scholar 

  15. McArdle N, Singh B, Murphy M, Gain KR, Maguire C, Mutch S, Hillman DR (2010) Continuous positive airway pressure titration for obstructive sleep apnoea: automatic versus manual titration. Thorax 65:606–611

    Article  PubMed  Google Scholar 

  16. Damjanovic D, Fluck A, Bremer H, Muller-Quernheim J, Idzko M, Sorichter S (2009) Compliance in sleep apnoea therapy: influence of home care support and pressure mode. Eur Respir J 33:804–811

    Article  PubMed  CAS  Google Scholar 

  17. Galetke W, Anduleit N, Richter K, Stieqlitz S, Randerath WJ (2008) Comparison of automatic and continuous positive airway pressure in a night-by-night analysis: a randomized, crossover study. Respiration 75:163–169

    Article  PubMed  Google Scholar 

  18. Fietze I, Glos M, Moebus I, Witt C, Penzel T, Baumann G (2007) Automatic pressure titration with APAP is as effective as manual titration with CPAP in patients with obstructive sleep apnea. Respiration 74:279–286

    Article  PubMed  Google Scholar 

  19. Patruno V, Aiolfi S, Costantino G, Murgia R, Selmi C, Malliani A, Montano N (2007) Fixed and autoadjusting continuous positive airway pressure treatments are not similar in reducing cardiovascular risk factors in patients with obstructive sleep apnea. Chest 131:1393–1399

    Article  PubMed  Google Scholar 

  20. Resta O, Carratu P, Depalo A, Giliberti T, Ardito M, Marrone O, Insalaco G (2004) Effects of fixed compared to automatic CPAP on sleep in obstructive sleep apnoea syndrome. Monaldi Arch Chest Dis 61:153–156

    PubMed  CAS  Google Scholar 

  21. Hukins C (2004) Comparative study of autotitrating and fixed-pressure CPAP in the home: a randomized, single-blind crossover trial. Sleep 27:1512–1517

    PubMed  Google Scholar 

  22. Hussain SF, Love L, Burt H, Fleetham JA (2004) A randomized trial of auto-titrating CPAP and fixed CPAP in the treatment of obstructive sleep apnea–hypopnea. Respiratory Medicine 98:330–333

    Article  PubMed  Google Scholar 

  23. Planes C, D’Ortho MP, Foucher A, Berkani M, Leroux K, Essalhi M, Delclaux C, Quera-Salva MA, Lofaso F (2003) Efficacy and cost of home-initiated auto-nCPAP versus conventional nCPAP. Sleep 26:156–160

    PubMed  Google Scholar 

  24. Massie CA, McArdle N, Hart RW, Schmidt-Nowara WW, Lankford A, Hudgel DW, Gordon N, Douglas NJ (2003) Comparison between automatic and fixed positive airway pressure therapy in the home. Am J Respir Crit Care Med 167:20–23

    Article  PubMed  Google Scholar 

  25. Randerath WJ, Schraeder O, Galetke W, Feldmeyer F, Ruhle KH (2001) Autoadjusting CPAP therapy based on impedance efficacy, compliance and acceptance. Am J Respir Crit Care Med 163:652–657

    PubMed  CAS  Google Scholar 

  26. Hudgel DW, Fung C (2000) A long-term randomized, cross-over comparison of auto-titrating and standard nasal continuous airway pressure. Sleep 23:645–648

    PubMed  CAS  Google Scholar 

  27. D’Ortho MP, Grillier-Lanoir V, Levy P, Goldenberg F, Corriger E, Harf A, Lofaso F (2000) Constant vs automatic continuous positive airway pressure therapy: home evaluation. Chest 118:1010–1017

    Article  PubMed  Google Scholar 

  28. Teschler H, Wessendorf TE, Farhat AA, Konietzke N, Berthon-Jones M (2000) Two months auto-adjusting versus conventional nCPAP for obstructive sleep apnoea syndrome. Eur Respir J 15:990–995

    Article  PubMed  CAS  Google Scholar 

  29. Konermann M, Sanner BM, Vyleta M, Laschewski F, Groetz J, Sturm A, Zidek W (1998) Use of conventional and self-adjusting nasal continuous positive airway pressure for treatment of severe obstructive sleep apnea syndrome: a comparative study. Chest 113:714–718

    Article  PubMed  CAS  Google Scholar 

  30. Series F, Marc I (1997) Efficacy of automatic continuous positive airway pressure therapy that uses an estimated required pressure in the treatment of the obstructive sleep apnea syndrome. Ann Intern Med 127:588–595

    PubMed  CAS  Google Scholar 

  31. Meurice JC, Mare I, Series F (1996) Efficacy of auto-CPAP in the treatment of obstructive sleep apnea/hypopnea syndrome. Am J Respir Crit Care Med 153:794–798

    PubMed  CAS  Google Scholar 

  32. Scharf MB, Brannen DE, McDannold MD, Berkowitz DV (1996) Computerized adjustable versus fixed NCPAP treatment of obstructive sleep apnea. Sleep 19:491–496

    PubMed  CAS  Google Scholar 

  33. Iber C, Ancoli-Israel S, Chesson A, Quan SF (2009) The AASM manual for the scoring of sleep and associated events: rules, terminology and technical specification. Sleep Medicine 10:799–808

    Article  Google Scholar 

  34. Mulgrew AT, Cheema R, Fleetham J, Ryan CF, Ayas NT (2007) Efficacy and patient satisfaction with auto-adjusting CPAP with variable expiratory pressure versus standard CPAP: a randomized crossover trial. Sleep Breath 11:31–37

    Article  PubMed  CAS  Google Scholar 

  35. Marrone O, Resta O, Salvaggio A, Giliberti T, Stefano A, Insalaco G (2004) Preference for fixed or automatic CPAP in patients with obstructive sleep apnea syndrome. Sleep Med 5:247–251

    Article  PubMed  CAS  Google Scholar 

  36. To KW, Chan WC, Choo KL, Lam WK, Wong KK, Hui DS (2008) A randomized cross-over study of auto-continuous positive airway pressure versus fixed-continuous positive airway pressure in patients with obstructive sleep apnoea. Respirology 13:79–86

    PubMed  Google Scholar 

Download references

Acknowledgments

We sincerely thank the technicians and physicians at the Department of Sleep Disorder Center for teaching us lots of knowledge about the PSG and the CPAP devices.

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. Department of Sleep Disorder Center, Nanfang Hospital, Southern Medical University, No. 1838 Guangzhou Dadao Bei, Guangzhou, 510515, China

    Ting Xu, Taoping Li, Yuan Feng, Lewu Xian, Haiqing Wu & Jian Xu

  2. Department of Neurology of the 309th Hospital of PLA, Beijing, 100091, China

    Dongning Wei

Authors
  1. Ting Xu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Taoping Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Dongning Wei
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yuan Feng
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Lewu Xian
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Haiqing Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jian Xu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Taoping Li.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Xu, T., Li, T., Wei, D. et al. Effect of automatic versus fixed continuous positive airway pressure for the treatment of obstructive sleep apnea: an up-to-date meta-analysis. Sleep Breath 16, 1017–1026 (2012). https://doi.org/10.1007/s11325-011-0626-6

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11325-011-0626-6

Keywords

Search

Navigation