Patients More Likely to Adhere to Fixed CPAP Versus Automatic Titration Option

Neeraj Kaplish, MD

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Patients with obstructive sleep apnea (OSA) are more likely to adhere to and report greater satisfaction with fixed continuous positive airway pressure (FCPAP) compared to automatic CPAP for the treatment of their chronic condition, according to new study findings.

Data presented during late-breaking abstracts at the SLEEP 2024 Annual Meeting in Houston, TX, this weekend showed that patients with OSA were more likely to report longer duration of CPAP use—by both hours during the day, and days during the year—when using a fixed device versus an automatic device. The findings support recommended use of fixed CPAP therapy in instances when patients can afford to choose between a consistent flow of pressure through an entire sleep period, versus a varying delivery of pressure based on airflow resistance.

Investigators led by Neeraj Kaplish, MD, of the department of neurology at University of Michigan, sought to identify associations between CPAP modalities, initial adherence to said CPAP options, and measures of patient therapy satisfaction.

“Positive airway pressure is considered the most effective treatment for OSA,” the team wrote, “however, clinical practice has diverged widely as to which PAP initiation strategy to use FCPAP or auto-CPAP.”

Research has long considered the difference among the CPAP modalities’ efficacy and tolerability in patients, with some evidence suggesting patients with higher requirements for CPAP may benefit more from auto-titration versus the fixed-pressure option. Other investigations have advocated for automatic CPAP serving primarily as an initial OSA therapy for the sake of pressure titration, before switching the cost-effective fixed CPAP method.

Kaplish and colleagues conducted a cross-sectional study assessing initial adherence and therapy data collected by Southeast Michigan durable medical equipment companies. Their assessment included new CPAP users aged ≥18 years old treated for OSA between January – December 2022. Their logistic regression analysis was observed for unadjusted and adjusted models, the latter factoring in patient demographics and OSA clinical characteristics.

The team sought associations between CPAP modality and treatment adherence—defined as CPAP use of ≥4 hours daily for ≥70% of the last 30 days—and patient therapy satisfaction. Linear regression models were used to interpret associations between CPAP modality and treatment adherence based on total days used, percent days used for ≥4 hours, and average hours on CPAP used.

The study included 482 patients; mean patient age was 51.9 years old and median body mass index was 33.8 kg/m2. Approximately half (50.4%) were female. Among the population, 201 patients were using FCPAP and 281 were using auto-CPAP. Patients using FCPAP were on average, older with higher apnea-hypopnea index (AHI) scores at baseline, and reported more median mask leaks. They were additionally more likely to be diagnosed via polysomnogram than auto-CPAP patients.

Investigators observed higher CPAP adherence among FCPAP users versus auto-CPAP users (61.7% vs 57.7%); however, the difference was not considered statistically significant (P = .37).The adjusted logistic regression model analysis showed significant associations between FCPAP modality and patient treatment satisfaction (odds ratio [OR], 1.5; 95% CI, 1.0 – 2.4), but not treatment adherence.

Investigators additionally observed in the adjusted linear regression model that FCPAP users reported increased hours of CPAP use daily (β = 0.5 hours; 95% CI, 0.1 - 0.8); greater total days of CPAP used (β = 4.9; 95% CI, -0.4 to 10.3) and higher percent days of CPAP used for >4 hours (β = 4.6%; 95% CI, -1.5 to 10.7).

“This study highlights higher patient satisfaction and some improvement of CPAP adherence among FCPAP compared to auto-CPAP users,” the team concluded.

References

1. ^{Kaplish N, Gavidia R, Adams M, Martin A, et al. CPAP vs. APAP: Associations with Adherence and Satisfaction in Practice. Paper presented at: Associated Professional Sleep Societies (SLEEP) 2024 Annual Meeting. Houston, TX. June 1 – 5, 2024.}
2. ^{Massie CA, McArdle N, Hart RW, et al. Comparison between automatic and fixed positive airway pressure therapy in the home. Am J Respir Crit Care Med. 2003;167(1):20-23. doi:10.1164/rccm.200201-022OC}
3. ^{Perin C, Genta PR. Less may be more: CPAP vs. APAP in the treatment of obstructive sleep apnea. J Bras Pneumol. 2021;47(6):e20210455. Published 2021 Dec 15. doi:10.36416/1806-3756/e20210455}