Better Adherence And Less Sleepiness-Wakefulness Inability And Fatigue On Continuous Positive Airway Pressure (Cpap) Than On Auto-Titrating Positive Airway Pressure (Apap) In A Large Clinic Sample

The objective of this project was to test whether there were better outcomes on Continuous Positive Airway Pressure (CPAP) than on Auto-titrating Positive Airway Pressure (APAP) in an unselected clinic sample of obstructive sleep apnea (OSA) patients. Patients were started preferably on CPAP based on a CPAP titration polysomnography (PSG) or APAP (depending on third party payer requirements). Patients not tolerating or responding to APAP were switched to CPAP based on a CPAP titration PSG. Data from patients prescribed PAP in 2015-16 were analyzed. Patients switching from APAP to CPAP were compared for sleepiness (Sleepiness- Wakefulness Inability and Fatigue Test or SWIFT), and PAP adherence (percentage of days with ≥4 h use and whether there was ≥4 h use on ≥70% days). Patients initially started on APAP were similarly compared with those initially started on CPAP. 143 patients switched from APAP to CPAP had improvement in SWIFT (6.3 vs. 7.6, p<0.001) and adherence (79.9% vs. 74.5%, p=0.003), with more becoming adherent (84.6% vs. 69.9%, p=0.005). Epworth Sleepiness Scale (ESS) also improved. Before the switch, these 143 patients had higher SWIFT on APAP than patients who stayed on APAP, with no difference in adherence. 296 patients initially started on CPAP had no difference in SWIFT (6.6 vs 7.3, p=0.158), but had higher adherence (80.8% vs. 74.7%, p=0.009) than 213 patients started on APAP, with more being adherent (85.8% vs. 73.2%, p=0.001). Patients have better outcomes (sleepiness, adherence) on CPAP than on APAP. Added to other literature evidence that APAP is inferior to CPAP for improvement in blood pressure, heart rate variability, oxygen desaturation index and insulin resistance, and may cause more sympathetic overactivity, this should result in re-examination of the role of APAP. If APAP is used first anyway, trouble tolerating it or an insufficient clinical response should lead to consideration of a switch to CPAP based on a CPAP titration PSG. Support (If Any)