P215 Continuous positive airway pressure (cpap) versus auto-cpap (apap) for the initial treatment of obstructive sleep apnoea syndrome: clinical efficacy and cost
| Autor: | I Valero-Sanchez, Ian Smith, Martina Mason, J Archer |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
medicine.medical_specialty
business.industry medicine.medical_treatment Epworth Sleepiness Scale digestive oral and skin physiology Significant difference Auto cpap nervous system diseases respiratory tract diseases Surgery Anesthesia medicine Initial treatment Continuous positive airway pressure Clinical efficacy Lead (electronics) business Obstructive sleep apnoea syndrome |
| Zdroj: | Sleep and breathing. |
| Popis: | Introduction and Objectives APAP has been shown to be an effective way of titrating CPAP levels. Systematic reviews have shown similar treatment effects for APAP and CPAP. APAP devices are increasingly used for outpatient initiation of CPAP and subsequent long term use. In this service evaluation we assessed the clinical effectiveness and cost implications of APAP pressure titration followed by switching to long term CPAP. Methods We collected data on 93, newly diagnosed patients with OSAS, starting on PAP, at baseline and at a 3 months follow-up visit. Patients initiated on APAP in an outpatient setting were asked to return in 2 weeks’ time to swap APAP for CPAP, set at average pressure estimated by APAP. The compliance, Epworth Sleepiness Scale (ESS) score and physiological indices; mean nocturnal SpO 2 , 4% oxygen desaturation index (ODI), from nocturnal oximetry were collected at 3 months. Cost of device CPAP vs. long term APAP were compared. We also compared outcomes between patients with mild and moderate/severe OSA (ODI≥15). Results Following 3 months of treatment patients had clinically and statistically significant improvements in measured parameters aside from change in weight (Table 1). There was no significant difference in CPAP compliance between patients with mild and moderate/severe OSA, 5.6 (3.2–6.9) vs. 5.3 (3.7–7.0) hours/night respectively, p=0.9. We found 74% of patients with mild OSA and 75% of patients with moderate/severe OSA used CPAP for ≥4 hours. Patients with mild OSA were sleepy with median ESS 12 (10–15) and treatment with CPAP led to significant reduction to ESS 8 (4–11), at 3 months. No patients asked to be transferred back to APAP. Transferring patients to CPAP, after initial APAP pressure titration, led to a calculated cost saving of £1 98 144 p/a, estimating that 1536 new patients initiate CPAP each year. Conclusions - Auto CPAP titration pathway is effective in terms of the outcomes measured. - Good compliance with significant reduction in ESS has been shown in patients with mild OSA, confirming that appropriately selected mild OSA patients can benefit from CPAP. - Transferring patients from APAP to long term CPAP can lead to significant cost reduction. |
| Databáze: | OpenAIRE |
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