Comparison of Two Telemonitoring Auto-titrating Modalities in OSA Patients

In patients with obstructive sleep apnea (OSA) on CPAP treatment, a CPAP titration test is usually performed to achieve the optimal pressure to maintain upper airway patency, abolish obstructive respiratory events and reduce the occurrence of adverse events. This pressure is called titration pressure.

Until now, we used to perform, after an adaptation period, a single-night outpatient test with an automated device preset on auto-adjusting pressure modality (APAP).

The incremental fixed pressure modality (EZ START) was initially developed to ease patients into having a positive sleep therapy experience from the very beginning. This mode gradually increases air pressure night-by-night until the preset therapeutic pressure is reached. In each good therapy session, the device performs in fixed pressure overnight and we get a real residual apnea-hypopnea index (rAHI).

For this study, we will use the same device (DreamStation auto CPAP, Philips Respironics, Murrysville, PA, USA), a web-based system to telemonitor patient therapy (EncoreAnywhere) and perform for each individual patient the two modalities in a telemonitoring crossover randomized single-blind (patient) way.

Inclusion criteria

• Age 18-80
• OSA diagnosis
• CPAP therapy indication

Exclusion criteria

• Previous CPAP therapy
• Severe COPD
• Respiratory insufficiency
• Obesity-hypoventilation syndrome
• Cardiac failure
• Recent cerebrovascular disease
• Central apnea, Cheyne Stokes or similar
• Important nasal insufficiency or malformation
• Previous pharyngeal surgery
• Shift work
• Psychosocial disability
• Refusal to participate