Autoadjusted versus fixed CPAP for obstructive sleep apnoea: a multicentre, randomised equivalence trial
Open accessAbstract
Background: The obstructive sleep apnoea syndrome (OSAS) is conventionally treated by continuous positive airway pressure set at a fixed level (fCPAP). Automatic mask pressure adjustment (autoCPAP) is increasingly used during home therapy. We investigated whether autoCPAP is equivalent to fCPAP in improving sleepiness in patients with OSAS in the long-term. Methods: In this multicentre equivalence trial, 208 patients with OSAS, with median Epworth sleepiness score (ESS) 13, apnoea/hypopnoea index 48.4/hour, were randomised to treatment with autoCPAP (5–15 mbar) or fCPAP (pressure set at the 90th percentile applied by autoCPAP during 2–4 weeks adaptation). Coprimary outcomes were changes in subjective and objective sleepiness from baseline to 2 years after treatment. Equivalence ranges were ±2 points in ESS and ±3 min sleep resistance time evaluated by recording responses to light signals. Results: At 2 years, in the intention to treat analysis, the reduction in sleepiness versus pretreatment baseline was similar in patients using autoCPAP (n=113, mean ESS-change −6.3, 95% CI −7.1 to −5.5; sleep resistance time +8.3 min, +6.9 to +9.7) and fCPAP (n=95, mean ESS-change −6.2, 95% CI −7.0 to −5.3; sleep resistance time +6.3 min, +4.7 to +7.8). The 95% CI of difference in ESS-reduction between autoCPAP and fCPAP was −0.9 to +1.4 and the 95% CI of difference in increase in sleep resistance time was −2.6 to +1.0 min. Blood pressure reduction and OSAS-related costs were similar between groups. Conclusions: AutoCPAP and fCPAP are equivalent within prespecified ranges in improving subjective and objective sleepiness in patients with OSAS over the course of 2 years. Costs of these treatments are similar. Trial registration number: ClinicalTrials.gov NCT00280800.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The randomized equivalence trial of 208 sleepy patients by Bloch et al. comparing APAP with CPAP demonstrated ESS reductions of 6.3 and 6.2, respectively.
“The randomized equivalence trial of 208 sleepy patients (mean ESS 13.1) by Bloch et al.1036 comparing APAP to CPAP demonstrated reductions of ESS scores of 6.3 and 6.2, respectively.”
From International Consensus Statement on Obstructive Sleep Apnea (2023) · cites this paper as [1036]
The Results report a randomized equivalence trial of 208 patients and mean ESS reductions of 6.3 points with autoCPAP and 6.2 with fixed CPAP at 24 months. However, the citing sentence’s baseline mean ESS of 13.1 is not supported: the trial table lists baseline means of 13.3 and 13.5 for the two groups, while the Abstract gives an overall median of 13. (LLM, conf=0.88)
Experimental — accuracy not yet measuredAdditional 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 [1036]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
SF-36 health survey: Manual and interpretation guide
Ware, J. (2003) · Medical Entomology and Zoology · Cited by 11,424 · see citing works
Multiple imputation using chained equations: Issues and guidance for practice
White, I. R., Royston, P., & Wood, A. M. (2011) · Statistics in Medicine · doi:10.1002/sim.4067 · Cited by 9,792 · see citing works
Adult Obstructive Sleep Apnea Task Force of the American Academy of Sleep Medicine, Epstein, L. J., Kristo, D., Strollo, P. J., Friedman, N., Malhotra, A., Patil, S. P., Ramar, K., Rogers, R., Schwab, R. J., et al. (2009) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.27497 · Cited by 3,360 · see citing works
The estimation of a preference-based measure of health from the SF-36.
Brazier, J., Roberts, J., & Deverill, M. (2002) · Journal of Health Economics · doi:10.1016/s0167-6296(01)00130-8 · Cited by 3,164 · see citing works
Law, M. R., Morris, J. K., & Wald, N. J. (2009) · BMJ · doi:10.1136/bmj.b1665 · Cited by 2,775 · see citing works
Prevalence of sleep-disordered breathing in the general population: the HypnoLaus study
Heinzer, R., Vat, S., Marques-Vidal, P., Marti-Soler, H., Andries, D., Tobback, N., Mooser, V, Preisig, M., Malhotra, A., Waeber, G., et al. (2015) · The Lancet Respiratory Medicine · doi:10.1016/s2213-2600(15)00043-0 · Cited by 2,481 · see citing works
Piaggio, G., Elbourne, D. R., Pocock, S. J., Evans, S. J. W., Altman, D. G., & CONSORT Group, F. T. (2012) · JAMA · doi:10.1001/jama.2012.87802 · Cited by 2,428 · see citing works
Effect Sizes for Interpreting Changes in Health Status
Kazis, L. E., Anderson, J. J., & Meenan, R. F. (1989) · Medical Care · doi:10.1097/00005650-198903001-00015 · Cited by 2,401 · see citing works
Adult obstructive sleep apnoea
Jordan, A. S., McSharry, D. G., & Malhotra, A. (2014) · The Lancet · doi:10.1016/s0140-6736(13)60734-5 · Cited by 1,735 · see citing works
Trials to assess equivalence: the importance of rigorous methods: Fig 1
Jones, B., Jarvis, P., Lewis, J. A., & Ebbutt, A. F. (1996) · BMJ · doi:10.1136/bmj.313.7048.36 · Cited by 1,032 · see citing works
Yokoe, T., Minoguchi, K., Matsuo, H., Oda, N., Minoguchi, H., Yoshino, G., Hirano, T., & Adachi, M. (2003) · Circulation · doi:10.1161/01.cir.0000052627.99976.18 · Cited by 961 · see citing works
An Instrument to Measure Functional Status Outcomes for Disorders of Excessive Sleepiness
(1997) · Sleep · doi:10.1093/sleep/20.10.835 · Cited by 881 · see citing works
Association Between Treated and Untreated Obstructive Sleep Apnea and Risk of Hypertension
Marin, J. M., Agusti, A., Villar, I., Forner, M., Nieto, D., Carrizo, S. J., Barbé, F., Vicente, E., Wei, Y., Nieto, F. J., et al. (2012) · JAMA · doi:10.1001/jama.2012.3418 · Cited by 781 · see citing works
Sample sizes for clinical trials with normal data.
Julious, S. A. (2004) · Statistics in Medicine · doi:10.1002/sim.1783 · Cited by 605 · see citing works
Chesson, A. L., Berry, R. B., & Pack, A. I. (2003) · SLEEP · doi:10.1093/sleep/26.7.907 · Cited by 344 · see citing works
Morgenthaler, T. I., Aurora, R. N., Brown, T., Zak, R., Alessi, C., Boehlecke, B. A., Chesson, A. L., Friedman, L., Kapur, V. K., Maganti, R. K., et al. (2008) · SLEEP · doi:10.1093/sleep/31.1.141 · Cited by 333 · see citing works
Alternative Methods of Titrating Continuous Positive Airway Pressure
Masa, J. F., Jiménez, A. L., Duran, J., Capote, F., Monasterio, C., Mayos, M., Terán, J., Hernández, L., Barbé, F., Maimó, A., et al. (2004) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.200312-1787oc · Cited by 327 · see citing works
Robinson, G. V. (2004) · Thorax · doi:10.1136/thx.2003.018739 · Cited by 318 · see citing works
German Version of the Epworth Sleepiness Scale
Bloch, K. E., Schoch, O. D., Zhang, J., & Russi, E. W. (1999) · Respiration · doi:10.1159/000029408 · Cited by 289 · see citing works
Self-citationMcDaid, C., Griffin, S. C., Weatherly, H. L. A., Durée, K. H., van der Burgt, M., Hout, S. V., Akers, J., Davies, R., Sculpher, M. J., & Westwood, M. E. (2009) · Health Technology Assessment · doi:10.3310/hta13040 · Cited by 239 · see citing works
A behavioural test to assess daytime sleepiness in obstructive sleep apnoea
BENNETT, L. S., Stradling, J. R., & DAVIES, R. (1997) · Journal of Sleep Research · doi:10.1046/j.1365-2869.1997.00039.x · Cited by 221 · see citing works
Position paper on the management of patients with obstructive sleep apnea and hypertension
Parati, G., Lombardi, C., Hedner, J. A., Bonsignore, M. R., Grote, L., Tkáčová, R., Levy, P. A., Riha, R. L., Bassetti, C. L., Narkiewicz, K., et al. (2012) · Journal of Hypertension · doi:10.1097/hjh.0b013e328350e53b · Cited by 219 · see citing works
Smith, I., & Lasserson, T. J. (2009) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd003531.pub3 · Cited by 151 · see citing works
Ip, S., D'Ambrosio, C., Patel, K., Obadan, N., Kitsios, G. D., Chung, M., & Balk, E. M. (2012) · Systematic Reviews · doi:10.1186/2046-4053-1-20 · Cited by 148 · see citing works
Bratton, D. J., Gaisl, T., Schlatzer, C., & Kohler, M. (2015) · The Lancet Respiratory Medicine · doi:10.1016/s2213-2600(15)00416-6 · Cited by 107 · see citing works
Self-citationWest, S. D. (2006) · Thorax · doi:10.1136/thx.2005.046300 · Cited by 93 · see citing works
Vennelle, M., White, S., Riha, R. L., Mackay, T. W., Engleman, H. M., & Douglas, N. J. (2010) · Sleep · doi:10.1093/sleep/33.2.267 · Cited by 74 · see citing works
Senn, O., Brack, T., Matthews, F., Russi, E. W., & Bloch, K. E. (2003) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.200304-542oc · Cited by 73 · see citing works
Self-citationNussbaumer, Y., Bloch, K. E., Genser, T., & Thurnheer, R. (2006) · Chest · doi:10.1378/chest.129.3.638 · Cited by 63 · see citing works
Self-citationPépin, J. L., Tamisier, R., Baguet, J. P., Lepaulle, B., Arbib, F., Arnol, N., Timsit, J. F., & Lévy, P. (2016) · Thorax · doi:10.1136/thoraxjnl-2015-207700 · Cited by 63 · see citing works
Xu, T., Li, T., Wei, D., Feng, Y., Xian, L., Wu, H.-Q., & Xu, J. (2011) · Sleep And Breathing · doi:10.1007/s11325-011-0626-6 · Cited by 50 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Tietjens, J. R., Claman, D., Kezirian, E. J., De Marco, T., Mirzayan, A., Sadroonri, B., Goldberg, A. N., Long, C., Gerstenfeld, E. P., & Yeghiazarians, Y. (2019) · Journal of the American Heart Association · doi:10.1161/jaha.118.010440 · Cited by 397 · see citing works
International Consensus Statement on Obstructive Sleep Apnea
Chang, J. L., Goldberg, A. N., Alt, J. A., Mohammed, A., Ashbrook, L., Auckley, D., Ayappa, I., Bakhtiar, H., Barrera, J. E., Bartley, B. L., et al. (2023) · International Forum of Allergy & Rhinology · doi:10.1002/alr.23079 · Cited by 350 · see citing works
- Authors
- Bloch, K. E., Huber, F., Furian, M., Latshang, T. D., Lo Cascio, C. M., Nussbaumer-Ochsner, Y., Senn, O., Russi, E. W., Kohler, M., Schoch, O. D., Turk, A., Imhof, E., Laube, I., Matthews, F., & Thurnheer, R.
- Affiliations
- University of Zurich (CH)
- University Hospital Zurich (CH)
- Kantonsspital St. Gallen (CH)
- Triemli Hospital (CH)
- Kantonsspital Münsterlingen (CH)
- Corresponding author
- Bloch, Konrad E
- Venue
- Thorax
- Publisher
- BMJ
- Published
- 2017-10-05
- Volume
- 73
- Issue
- 2
- Pages
- 174-184
- ISSN
- 0040-6376 (ISSN-L)
- 1468-3296
- OpenAlex
- W2763481489
- Semantic Scholar
- 0ed84ecb282da9a9c2e6f909cf6cb57821fa09b0
- Cited by
- 35
- References
- 31
- Citations by year
- 2026: 1 · 2025: 4 · 2024: 3 · 2023: 3 · 2022: 6 · 2021: 3 · 2020: 5 · 2019: 6 · 2018: 4
- FWCI
- 3.03
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Thorax (publishedVersion)
- PubMed (publishedVersion)
- Zurich Open Repository and Archive (University of Zurich) (acceptedVersion)
- HighWire Press Open Archive (submittedVersion)
- Zurich Open Repository and Archive (University of Zurich) (submittedVersion)
- Zurich Open Repository and Archive (University of Zurich)
- Funders
- Respironics Foundation
- Lung League Zurich, Switzerland
- Swiss National Science Foundation
- Lunge League St. Gallen, Switzerland
- Lunge League Thurgau, Switzerland
- ResMed Switzerland
- 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, daytime sleepiness, Epworth sleepiness score, blood pressure, treatment costs, equivalence
- MeSH terms
- Equivalence Trials as Topic, Adolescent, Adult, Aged, Female, Humans, Male, Middle Aged, Time Factors, Cohort Studies, Treatment Outcome, Sleep Apnea, Obstructive, Continuous Positive Airway Pressure, Young Adult
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
