Bi-CPAP is reported to improve adherence to treatment in OSAS. In our centre, in common with many centres in the UK, initiation of CPAP therapy is performed in a single visit in an out-patient setting. We asked newly diagnosed OSAS patients to express a preference for conventional CPAP or Bi-CPAP after 10 minute periods of use of both techniques and investigated if the preference was related to pattern of breathing and reduction in expiratory PAP (EPAP). 15 adult patients with newly diagnosed OSAS were randomly allocated to receive CPAP/Bi-CPAP or Bi-CPAP/CPAP using the Respironics CFLEX system, with the device set to provide either conventional CPAP or maximum reduction in EPAP. Patients were informed that there might be a difference in the sensation of breathing but were not informed of the order of testing. Rib Cage and Abdominal excursion and Mask Pressure were monitored continuously. 60% of patients preferred Bi-CPAP. For the 15 patients there were no significant differences in breathing pattern between the two periods. In the patients preferring Bi-CPAP there was a small increase in respiratory frequency from 13/min on CPAP to 14/min on Bi-CPAP (p<0.05).The reduction in EPAP was variable ( Mean EPAP(CPAP, 9.51) - Mean EPAP(Bi-CPAP, 8.75 ) = 0.76 cmH20 (range -0.59 to 2). There was no difference in mean EPAP reduction in the group preferring Bi-CPAP compared with those preferring CPAP. An order effect emerged with patients receiving Bi-CPAP first showing a preference for this. Patients with OSAS show a slight preference for Bi-CPAP at out-patient initiation but this is not related to breathing pattern or reduction in mean EPAP level.
Gribbin HR, Daya A, Thomas S, Dodds C. Preference for Bilevel Continuous Positive Airway Pressure and Breathing Pattern in patients with Obstructive Sleep Apnoea Syndrome at Out-patient CPAP Set-Up. 19th Congress of the European Sleep Research Society. Glasgow, September 2008.
Abdul Daya, Cleveland Unit, Middlesbrough. Tel: +44 (0)1642-854-778.
Regional Medical Physics Department, Freeman Hospital, Newcastle upon Tyne, NE7 7DN, UK.
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