Continuous positive airway pressure titration for obstructive sleep apnoea: automatic versus manual titration
Open accessAbstract
BACKGROUND AND AIMS: Manual laboratory continuous positive airway pressure (CPAP) titration for obstructive sleep apnoea (OSA) is costly, time intensive and delays access to treatment. Automatic positive airway pressure (APAP) titration has the potential to reduce cost and improve access to treatment. The aim of this study was to assess the clinical efficacy and costs of APAP titration compared with manual titration in moderate-severe OSA. METHODS: Patients with moderate-severe OSA (apnoea/hypopnoea index >15 and Epworth Sleepiness Score > or = 8) who were free of co-morbidities that could impair APAP titration were eligible. 249 participants were randomised to manual titration, home APAP or laboratory APAP titration to determine a fixed pressure for CPAP. Clinical and direct cost outcomes were assessed after 4 weeks of treatment. RESULTS: Average nightly CPAP use, subjective sleepiness, SF36 quality of life, Trails A and B cognitive function and polysomnographic outcomes were similar among the per-protocol groups. Non-hypertensive patients had a lower resting heart rate (and greater reduction in heart rate) at 4 weeks after laboratory APAP titration compared with home APAP titration. Costs per patient were highest in manual (AU$817.84), followed by laboratory (AU$647.56) and home (AU$132.09) APAP titration. An intention-to-treat analysis confirmed the effectiveness of APAP titration compared with manual titration in the standard clinical setting. CONCLUSIONS: Among patients with moderate-severe OSA without serious co-morbidities, outcomes at 1 month indicate that APAP titration is more cost-effective than manual laboratory titration to determine an appropriate pressure for CPAP for long-term use; with the largest savings occurring in the home APAP patients.
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Six studies evaluated cost, of which three reported a slightly reduced cost for a combined home-based diagnostic and treatment pathway, and three reported a lower cost for home APAP compared to in-laboratory titrations.
“Six studies evaluated cost, 35,175,177,[179][180][181] of which three 35,180,181 reported a slightly reduced cost for a combined home-based diagnostic and treatment pathway, and three 175,177,179 reported a lower cost for home APAP compared to in-laboratory titrations.”
Out-of-pocket costs to patients may be lower with either split or whole-night in-laboratory PAP titration due to payor coverage policies in certain instances.
“Despite the greater cost-effectiveness of homebased APAP initiation, 175,177,179 out-of-pocket costs to patients may be lower with either split or whole-night in-laboratory PAP titration due to payor coverage policies in certain instances.”
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- Authors
- McArdle, N., Singh, B., Murphy, M., Gain, K. R., Maguire, C., Mutch, S., & Hillman, D. R.
- Affiliations
- The University of Western Australia (AU)
- Sir Charles Gairdner Hospital (AU)
- Corresponding author
- McArdle, N.
- Venue
- Thorax
- Publisher
- BMJ
- Published
- 2010-07-01
- Volume
- 65
- Issue
- 7
- Pages
- 606-611
- ISSN
- 0040-6376 (ISSN-L)
- OpenAlex
- W2154124810
- Semantic Scholar
- 0101ffd1278dddef23cfea7218a33cde6d8a9926
- Cited by
- 43
- References
- 27
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 2 · 2023: 2 · 2022: 3 · 2021: 2 · 2020: 5 · 2019: 4 · 2017: 2 · 2016: 3 · 2015: 1 · 2014: 6 · 2013: 4 · 2012: 2
- FWCI
- 2.38
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Thorax (publishedVersion)
- UWA Profiles and Research Repository (UWA) (publishedVersion, other-oa)
- PubMed (publishedVersion)
- HighWire Press Open Archive (submittedVersion)
- Funders
- ResMed
- 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, CPAP titration, automatic positive airway pressure, cost-effectiveness, sleepiness, quality of life, cognitive function, heart rate, treatment access
- MeSH terms
- Adult, Blood Pressure, Female, Heart Rate, Humans, Male, Middle Aged, Patient Compliance, Severity of Illness Index, Treatment Outcome, Health Care Costs, Polysomnography, Sleep Apnea, Obstructive, Continuous Positive Airway Pressure
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