Really really thorough article about treatments for apnea

[Keljian]

So I found this: 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4561253/

It's full of really interesting information....

See points underlined: 

 Compared to CPAP, APAP demonstrates a small but statistically significant superiority in adherence (+11 minutes) as well as in reduction of sleepiness (−0.5 points in ESS). In contrast, evidence suggests that fixed CPAP level may be superior to APAP in blood pressure reduction and other cardiometabolic outcomes. 

Another use of APAP has been to determine CPAP level requirements in the home rather than a sleep laboratory. Typically, the patient is provided an APAP device for 5-7 nights and the device is then interrogated to identify the 90th or 95th percentile pressure required which is inferred to be their fixed CPAP requirement. Such a protocol has been demonstrated to identify CPAP requirements effectively. A diagnostic protocol combining home sleep testing followed by APAP titration has been shown to reduce costs of OSA diagnosis and treatment substantially, lower time to treatment, and improve CPAP adherence as compared to the traditional strategy of in-laboratory polysomnography and CPAP titration

Some have advocated the use of ASV in the treatment of CPAP-emergent central apneas as well; however, a randomized trial of CPAP vs. ASV in CPAP-emergent central apneas found no benefit of ASV in terms of PAP adherence or symptoms. Thus, there is currently no strong rationale for the use of ASV in this setting 

Residual sleepiness is common even in CPAP compliant OSA patients. Among those using CPAP >6 hours/night, subjective sleepiness is noted in 22% and objective sleepiness in 52% (170). The wake-promoting agent, modafinil, when added to CPAP, improves both subjective and objective measures of sleepiness with a mean effect on ESS of 6-7 points.

There is a LOT more in this medical article.. I'm just digesting it all at the moment

[Sleep2Snore]

Not had time to read it all, but

evidence suggests that fixed CPAP level may be superior to APAP in blood pressure reduction and other cardiometabolic outcomes.

I have just changed from CPAP to APAP and it has not affected it, however, sometimes these people look for decimal points, so it might have affected it.  But that would be just being a bit picky!
If anything I am a bit calmer using the APAP especially when if starts up.

I will read the rest later.

[Walla Walla]

Not had time to read it all, but

evidence suggests that fixed CPAP level may be superior to APAP in blood pressure reduction and other cardiometabolic outcomes.

After looking into this further I found that there were three trials comparing the APAP to the CPAP.  Two of the trials found no difference between the APAP and CPAP as far as blood pressure and other cardiometabolic outcomes.

The 3rd trial that did find a difference only tested 31 people during a 3 month span.
Not sure how this article concluded that CPAP is superior to APAP in blood pressure reduction.

[pholynyk]

It's interesting that the discussion of ASV usage doesn't mention the possibility of presentation Central SA or Complex SA as opposed to CPAP-emergent CSA. I don't know if that is because there aren't very many, or because the tests don't look for it. We see many here, but I'm not sure that AB posters are a representative sample of sleep apniacs.

[DeepBreathing]

Nothing really new here is there? In fact that is a weakness of this paper - it's really only a summary of existing research going back (in some cases) many years. It fails to address the rapid improvement in mask and machine design in the past few years, relying on a lot of outdated suppositions. The paper states that "For now, we regard fixed CPAP as the treatment of choice based on available data" without really giving any convincing data.

A big problem I see with a lot of these studies and meta-analyses is that the design of the studies varies so much that is extremely difficult to draw conclusions. Studies appear to contradict each other, typically have very small data sets and in most cases are not well controlled (ie double blind placebo control is difficult to achieve - CPAP isn't like an anonymous white pill). Consequently any review paper just ends of regurgitating a lot of contradictory results.

I was interested in the research into drug therapies which may potentially treat apnea without the need for xPAP therapy, though it looks like any real breakthrough is still a long way off.

[DeepBreathing]

It's interesting that the discussion of ASV usage doesn't mention the possibility of presentation Central SA or Complex SA as opposed to CPAP-emergent CSA.

Yeah, I think the paper is specifically addressed at obstructive apnea. In my experience, the great majority of doctors seem to think all apnea is obstructive and have a blind spot for central apnea. That's why we see so many people on the forum who have been prescribed a totally inappropriate machine to treat central apnea. That and the ridiculous insurance rules.

[holden4th]

The major problem with this paper (and DB has noted this) is that it contains no new research. It's basically a summary of sources gathered at random from the internet. If this was proffered as a PhD thesis (which it possibly was) it would have been sent back to the the author.