Autoadjusting nasal continuous positive airway pressure (CPAP) greatly reduces the apnoea/hypopnoea index (AHI), and affords a significant reduction in median pressure (P50) compared-with manually titrated conventional nasal CPAP. The aim of the present study was to test whether these benefits were maintained in the medium term at home, in a double-blind crossover study. Ten sequential subjects (mean AHI 52.9 /h) were enrolled. After a manual titration, subjects were randomly allocated to 2 months autoadjusting nasal CPAP (AutoSet), followed by 2 months with the AutoSet device in fixed pressure mode at the manually titrated pressure, or vice versa. The machine-scored AHI, P50, and median leak were recorded on 12 nights in each arm, and averaged. Mean +/- SEM AHI was 4.0 +/- 0.3 /h in auto mode, and 3.7 +/- 0.3 /h in manual mode (NS). Mean +/- SEM P50 was 7.2 +/- 0.4 cmH2O auto, 9.4 +/- 0.6 cmH2O manual, average reduction 23 +/- 4% (p < 0.0001). Auto "recommended" pressure was (mean +/- SEM) 10.1 +/- 0.5 cmH2O (p = 0.04 with respect to manual) and peak pressure typically 1 cmH2O higher. Median (+/- SEM) leak was 0.181 +/- 0.006 L/s auto (and uncorrelated with AHI or pressure), 0.20 +/- 0.006 L/s manual (p = 0.003). Compliance was 6.3 +/- 0.4 h in auto mode and 6.1 +/- 0.5 h in fixed mode (NS). Apnoea/hypopnoea index during 2 months of home autoadjusting nasal continuous positive airway pressure is comparable to that during conventionally titrated fixed pressure continuous positive airway pressure, while affording a 23% reduction in median pressure but no increase in compliance. Leak did not importantly affect autoadjustment.
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