Baseline Lighter Sleep and Lower Saturation Are Associated With Improved Sleepiness and Adherence on Continuous Rather Than Autotitrating Positive Airway Pressure

Clin EEG Neurosci. 2020 May;51(3):174-179. doi: 10.1177/1550059419892759. Epub 2019 Dec 18.


The objective was to test whether there were better outcomes on switching from autotitrating positive airway pressure (APAP) to continuous positive airway pressure (CPAP) in a clinic sample of patients with obstructive sleep apnea (OSA). Patients prescribed APAP in 2015-2016 and belonging to a subset characterized by side effects, or suboptimal response or adherence, were advised a switch to CPAP following a CPAP titration polysomnography. The main analysis was for improvement (after switch from APAP to CPAP) in (1) sleepiness, wakefulness inability, and fatigue, using change from baseline in the Sleepiness-Wakefulness Inability and Fatigue Test (delta SWIFT), and Epworth Sleepiness Scale (delta ESS), and (2) adherence using percentage of days with ≥4-hour use and whether there was ≥4-hour use on ≥70% days. To determine possible predictors for switching, additional analysis was performed for differences at baseline between patients switching and those staying on APAP. A total of 148 patients were switched from APAP to CPAP and had greater improvement in delta SWIFT (5.2 vs 4.1, P = .004), greater improvement in delta ESS (3.6 vs 2.9, P = .011), and better adherence (79.4% vs 74.3%, P = .006) on CPAP than on APAP. More patients were adherent on CPAP than on APAP (83.1% vs 68.9%, P = .006). Patients switching had higher baseline arousal index and stage N1 sleep, and lower nadir oxygen saturation, than 96 patients not switching. Thus, there is a subset of patients with better outcomes after switching to CPAP than on APAP. Patients with baseline lighter sleep (indicated by more arousals and stage N1), or greater desaturation, may be more likely to do better on CPAP than on APAP. CPAP may be the preferable treatment in a significant subset of patients. If APAP is used first anyway, side effects, or suboptimal response or adherence, should lead to consideration of switching to CPAP based on a CPAP titration polysomnography.

Keywords: adherence; arousal index; autotitrating positive airway pressure (APAP); continuous positive airway pressure (CPAP); fatigue; obstructive sleep apnea (OSA); sleepiness; stage N1; wakefulness inability.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Continuous Positive Airway Pressure*
  • Fatigue / complications
  • Female
  • Humans
  • Male
  • Middle Aged
  • Patient Compliance
  • Positive-Pressure Respiration*
  • Sleep Apnea, Obstructive / complications
  • Sleep Apnea, Obstructive / psychology
  • Sleep Apnea, Obstructive / therapy*
  • Sleepiness
  • Treatment Outcome
  • Young Adult