Role of APAP devices in the management of obstructive sleep apnea not established

October 06, 2003

OTTAWA — Auto-titrating nasal continuous positive airway pressure (APAP) devices show promise in the management of obstructive sleep apnea (OSA), but their place in therapy has yet to be established, a report released today by the Canadian Coordinating Office for Health Technology Assessment has concluded.

OSA is a sleep and breathing disorder defined as a combination of complete cessations of airflow (apneas) and partial cessations of airflow (hypopneas) lasting at least 10 seconds and occurring at least five times per hour of sleep. OSA may be associated with excessive daytime sleepiness, cognitive and personality problems and high blood pressure. An estimated 2-4% of the adult population in the US suffers from OSA; Canadian rates are likely similar.

The most common treatment for moderate to severe OSA is nasal continuous positive airway pressure (CPAP), delivered in a sleep laboratory. Continuous pressure is applied to the upper airways through a nasal mask connected to an airflow generator while the patient is sleeping. Since the pressure is manually adjusted to achieve optimal pressure (titration), CPAP is resource-intensive. There are also compliance problems with CPAP.

APAP devices auto-adjust pressure levels during sleep, taking account of the disappearance and reappearance of apneas and hypopneas and other physiological events. Potentially, they could be used unattended in sleep laboratory and home settings.

The CCOHTA report examines the role of APAP in the diagnosis, titration and treatment of OSA. Matters of interest to health care providers and users include the effectiveness and costs of APAP, and its appropriate place in relation to sleep laboratories and the use of conventional CPAP. The systematic review concludes:

• Observational studies show there is a potential use for APAP for the diagnosis of OSA. Further validation is needed from studies with stronger methodology.
• The use of APAP in auto-titration (i.e. unattended adjustment of pressure) has not been established.
• For the treatment of OSA, studies show that APAP uses a lower treatment pressure than CPAP. However, there was no significant difference in clinical outcomes between APAP and CPAP. It is uncertain whether there is better compliance with the use of APAP.
• Preliminary estimates show that APAP might provide cost savings over CPAP under certain conditions, but further cost studies are required.

The full report is available on-line at www.ccohta.ca.

CCOHTA is an independent not-for-profit health research organization funded by the Canadian federal, provincial and territorial governments. CCOHTA provides unbiased, reliable information about health technology. CCOHTA also manages a common review process for new drugs submitted for funding by participating federal, provincial and territorial drug benefit programs.

For more information contact: Kirk Fergusson, Communications, Director