Efficacy and cost of home-initiated auto-nCPAP versus conventional nCPAP

Study objectives: To compare in a multicenter prospective study the efficacy and cost of conventional nasal continuous positive airway pressure (nCPAP) initiated at the sleep laboratory versus auto-nCPAP initiated at home. Design: Patients with severe obstructive sleep apnea syndrome (OSAS) were randomized to treatment with either the REM+ auto device in constant mode at the effective pressure determined by titration at the sleep laboratory (n=17) or the REM+ auto device in automatic mode initiated at the patient's home by a nurse (n=18). After 2 months, the efficacy and cost of nCPAP therapy and the time from diagnosis to nCPAP were evaluated. All values are reported as means±SD. Patients: Thirty-five subjects with newly diagnosed OSAS (8 women and 27 men, mean age: 54.3 ± 10.6 years, apnea-hypopnea index (AHI) 58.1±14.0 h^-1). Interventions: N/A Measurements and Results: Both treatments were used properly and induced similar decreases in the AHI (7.6±6.9 vs. 10.4±12.5 h^-1 for autonCPAP and conventional nCPAP, respectively; NS) and Epworth Sleepiness score (from 15.5±4.7 to 7.5±3.4 vs. 14.7±3.9 to 7.6±3.4 for auto-nCPAP and conventional nCPAP, respectively; NS). With auto-nCPAP initiated at home, the time from diagnosis to final adjustment of nCPAP was shorter (16.3±5.0 vs. 47.2±46.5 days with conventional nCPAP, P<0.02) and the cost was lower (1263±352 vs. 1720±455 €, respectively; P<0.05), Conclusions: Treatment of OSAS with auto-nCPAP initiated at home is effective and reliable and reduces the time from diagnosis to therapy and the cost of treatment.