Auto‐adjusted versus fixed positive airway pressure in patients with severe OSA: A large randomized controlled trial

Abstract Background and Objective Continuous positive airway pressure (CPAP) in the treatment of severe obstructive sleep apnoea (OSA) can be used in fixed CPAP or auto‐adjusted (APAP) mode. The aim of this prospective randomized controlled clinical study was to evaluate the 3 month‐efficacy of CPAP used either in fixed CPAP or APAP mode. Methods Eight hundred one patients with severe OSA were included in twenty‐two French centres. After 7 days during which all patients were treated with APAP to determine the effective pressure level and its variability, 353 and 351 patients were respectively randomized in the fixed CPAP group and APAP group. After 3 months of treatment, 308 patients in each group were analysed. Results There was no difference between the two groups in terms of efficacy whatever the level of efficient pressure and pressure variability ( p = 0.41). Exactly, 219 of 308 patients (71.1%) in the fixed CPAP group and 212 of 308 (68.8%) in the APAP group ( p = 0.49) demonstrated residual apnoea hypopnoea index (AHI) <10/h and Epworth Score <11. Tolerance and adherence were also identical with a similar effect on quality of life and blood pressure evaluation. Conclusion The two CPAP modes, fixed CPAP and APAP, were equally effective and tolerated in severe OSA patients.