Fixed-pressure CPAP versus auto-adjusting CPAP: comparison of efficacy on blood pressure in obstructive sleep apnoea, a randomised clinical trial
Open accessAbstract
BACKGROUND: Millions of individuals with obstructive sleep apnoea (OSA) are treated by CPAP aimed at reducing blood pressure (BP) and thus cardiovascular risk. However, evidence is scarce concerning the impact of different CPAP modalities on BP evolution. METHODS: This double-blind, randomised clinical trial of parallel groups of patients with OSA indicated for CPAP treatment compared the efficacy of fixed-pressure CPAP (FP-CPAP) with auto-adjusting CPAP (AutoCPAP) in reducing BP. The primary endpoint was the change in office systolic BP after 4 months. Secondary endpoints included 24 h BP measurements. RESULTS: Patients (322) were randomised to FP-CPAP (n=161) or AutoCPAP (n=161). The mean apnoea+hypopnoea index (AHI) was 43/h (SD, 21); mean age was 57 (SD, 11), with 70% of males; mean body mass index was 31.3 kg/m(2) (SD, 6.6) and median device use was 5.1 h/night. In the intention-to-treat analysis, office systolic blood pressure decreased by 2.2 mm Hg (95% CI -5.8 to 1.4) and 0.4 mm Hg (-4.3 to 3.4) in the FP-CPAP and AutoCPAP group, respectively (group difference: -1.3 mm Hg (95% CI -4.1 to 1.5); p=0.37, adjusted for baseline BP values). 24 h diastolic BP (DBP) decreased by 1.7 mm Hg (95% CI -3.9 to 0.5) and 0.5 mm Hg (95% CI -2.3 to 1.3) in the FP-CPAP and AutoCPAP group, respectively (group difference: -1.4 mm Hg (95% CI -2.7 to -0.01); p=0.048, adjusted for baseline BP values). CONCLUSIONS: The result was negative regarding the primary outcome of office BP, while FP-CPAP was more effective in reducing 24 h DBP (a secondary outcome). TRIAL REGISTRATION NUMBER: NCT01090297.
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Additional randomized controlled trials demonstrated similar reductions in sleepiness and improvements in quality-of-life measures with APAP.
“Additional RCTs1036,1038 demonstrated similar findings in the reduction of sleepiness1036 and improvement in QOL measures.1039”
From International Consensus Statement on Obstructive Sleep Apnea (2023) · cites this paper as [1039]
The PP analysis reports that quality of life improved equally in the AutoCPAP and fixed-pressure CPAP arms. The Introduction says CPAP reduces sleepiness, but the trial results in our copy do not report a reduction in sleepiness with AutoCPAP; that part of the attributed claim is not supported by this study. (LLM, conf=0.85)
Experimental — accuracy not yet measuredRecent data suggest that the blood pressure reduction reported with APAP may not be as robust as with CPAP.
“Recent data suggest that the blood pressure reduction reported with APAP may not be as robust with CPAP”
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Self-citation
- Authors
- Pépin, J. L., Tamisier, R., Baguet, J. P., Lepaulle, B., Arbib, F., Arnol, N., Timsit, J. F., & Lévy, P.
- Affiliations
- Inserm (FR)
- Groupe Hospitalier Mutualiste de Grenoble (FR)
- Corresponding author
- Pépin, J L
- Venue
- Thorax
- Publisher
- BMJ
- Published
- 2016-04-18
- Volume
- 71
- Issue
- 8
- Pages
- 726-733
- ISSN
- 0040-6376 (ISSN-L)
- 1468-3296
- OpenAlex
- W2336233631
- Cited by
- 63
- References
- 53
- Citations by year
- 2026: 4 · 2025: 8 · 2024: 3 · 2023: 7 · 2022: 2 · 2021: 5 · 2020: 5 · 2019: 12 · 2018: 7 · 2017: 9 · 2016: 1
- FWCI
- 7.77
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Thorax (publishedVersion)
- PubMed (publishedVersion)
- HighWire Press Open Archive (submittedVersion)
- Funders
- Agir pour les Maladies Chroniques
- Topics
- Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Respiratory Support and Mechanisms
- Keywords
- obstructive sleep apnea, continuous positive airway pressure, blood pressure, 24-hour ambulatory blood pressure, cardiovascular risk, apnea-hypopnea index, medication adherence, lifestyle intervention, sleep-disordered breathing
- MeSH terms
- Adolescent, Adult, Aged, Aged, 80 and over, Blood Pressure, Double-Blind Method, Female, Humans, Male, Middle Aged, Obesity, Risk Factors, Body Mass Index, Polysomnography, Blood Pressure Monitoring, Ambulatory, Sleep Apnea, Obstructive, Continuous Positive Airway Pressure
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