Prospective randomized comparison of impedance-controlled auto-continuous positive airway pressure (APAPFOT) with constant CPAP

Randerath, Winfried J; Galetke, Wolfgang; David, Michaela; Siebrecht, Heidi; Sanner, Bernd; Rühle, Karl-Heinz

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Volume 2, Issue 2 , Pages 115-124, March 2001

Prospective randomized comparison of impedance-controlled auto-continuous positive airway pressure (APAP_FOT) with constant CPAP

Winfried J Randerath
- Department of Pneumology, Allergology and Sleep Medicine, Klinik Ambrock, University Witten/Herdecke, Ambrocker Weg 60, D-58091 Hagen, Germany
- Corresponding author. Tel.:+49-2331-9740; fax: +49-2331-974-209
Wolfgang Galetke
- Department of Pneumology, Allergology and Sleep Medicine, Klinik Ambrock, University Witten/Herdecke, Ambrocker Weg 60, D-58091 Hagen, Germany
Michaela David
- Department of Pneumology, Allergology and Sleep Medicine, Klinik Ambrock, University Witten/Herdecke, Ambrocker Weg 60, D-58091 Hagen, Germany
Heidi Siebrecht
- Department of Pneumology, Allergology and Sleep Medicine, Klinik Ambrock, University Witten/Herdecke, Ambrocker Weg 60, D-58091 Hagen, Germany
Bernd Sanner
- Department of Medicine I, Ruhr University Bochum, Marienhospital Herne, Germany
Karl-Heinz Rühle
- Department of Pneumology, Allergology and Sleep Medicine, Klinik Ambrock, University Witten/Herdecke, Ambrocker Weg 60, D-58091 Hagen, Germany

Received 13 January 2000; received in revised form 24 May 2000; accepted 14 June 2000.

Abstract

Background: The measurement of impedance permits reliable detection of obstructive apneas, hypopneas and upper airways resistance syndrome.

Objective: To establish whether impedance-controlled self-adjusting positive airway pressure therapy (APAP_FOT) is equally as good as constant continuous positive airway pressure (CPAP) in the treatment of sleep apnea syndrome (OSAS).

Methods: Twenty men and five women with OSAS (age 52.8±9.0 years, body mass index (BMI) 31.4±5.0 kg/m², AHI 32.2±18.1/h (mean±SD)) underwent baseline polysomnography, manual CPAP titration and two nights of treatment, one with APAP_FOT, one with constant CPAP.

Results: With both modes, a significant reduction in respiratory disturbances was seen (apnea/hypopnea index (AHI) baseline 32.2±18.1/h, constant CPAP 6.6±8.7, APAP_FOT 5.5±3.8/h, P<0.001 baseline vs. each treatment mode). Under APAP_FOT, the sleep profile was normalized (S3/4 baseline 16.3±13.9% total sleep time (TST), APAP_FOT 21.6±10.9% TST, P<0.05, rapid eye movement (REM) 14.2±6.7% TST vs. 20.3±7.3% TST, P<0.01), while with constant CPAP, a tendency towards improvement was found. The mean treatment pressure with APAP_FOT was significantly lower than the constant CPAP (5.7±2.1 vs. 8.3±1.6 mbar, P<0.001).

Conclusion: We conclude that APAP_FOT is at least as effective as constant CPAP in normalizing sleep and breathing in OSAS.

Keywords: Impedance, Forced oscillation technique, Automatic continuous positive airway pressure, Impedance-controlled self-adjusting positive airway pressure, Constant continuous positive airway pressure, Pressure reduction, Sleep apnea syndrome