SEATTLE, WA—Automated graduated continuous positive airway pressure (AGPAP) effectively treats obstructive sleep apnea (OSA) and may facilitate adherence in those newly diagnosed, especially in males who require moderate-to-high PAP pressures, a study concluded at SLEEP 2015.
“Although PAP is a highly effective treatment for sleep apnea, adherence to therapy remains an obstacle,” noted D. Alan Lankford, PhD, of the Sleep Disorders Center of Georgia in Atlanta, GA, in explaining the rationale for the study, which used AGPAP. With this treatment, described as an “extended duration CPAP ramp,” the patient first receives pressure below their prescription during an acclimation phase and then, based on usage, the algorithm gradually increases pressure to therapy level.
The goal of this multicenter, randomized, double-blind, controlled trial was determine effectiveness of the AGPAP acclimation period and its impact on short-term adherence.
Patients with newly diagnosed OSA prescribed CPAP (>10cmH20) were randomly assigned to AGPAP (n=95) or standard CPAP therapy (n=120), the control arm. Treatment efficacy was determined by comparing the Apnea Hypopnea Index (AHI) obtained from each of the two PAP devices during the acclimation period to the diagnostic polysomnography baseline AHI. “Adherence was monitored remotely,” Dr. Lankford noted.
During the acclimation period, the AHI was reduced by 92% Day 2 and 97% by Day 7. The average acclimation period was 13.9±10.5 days.
After three months, compared with the control group, average hours of use for all days tended to favor those in the AGPAP group (4.0±2.3 vs. 3.62±2.5 hours, P=0.23, n=95) as well as for all days where the device was used (4.95±1.7 vs. 4.62±2.1 hours, P=0.20).
Patients in the AGPAP arm “trended toward a higher percentage of nights with ≥4 hours of use,” he noted; which was 54.3±33.4% vs. 48.3±35.1% (P=0.20). In addition, a higher percentage of those in the AGPAP arm had adherence that met CMS criteria, 62.1% vs. 52.5% (P=0.17). Among patients who were male, compared with those in the control arm (n=59), those in the AGPAP group (n=71) were significantly more compliant, 4.3±2.4 vs 3.4±2.4 hours (P=0.04).