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The present study aimed to evaluate whether titration of fixed continuous positive airway pressure at home using telemonitoring produces patient outcomes equal to auto-adjusting positive airway pressure titration at home for patients with moderate obstructive sleep apnea. Patients were randomized with a 1:1 allocation ratio to receive either auto-adjusting positive airway pressure titration based on the median of the 95th percentile pressure across seven nights or fixed continuous positive airway pressure titration based on a fixed calculated pressure and specific adaptations after telemonitoring of device data after 3 and 7 nights. The results of the ambulatory titration were evaluated with in-laboratory polysomnography after 2 weeks. We hypothesized that fixed continuous positive airway pressure titration would be non-inferior to auto-adjusting positive airway pressure titration in respect to continuous positive airway pressure adherence at a 3-month follow-up. A non-inferiority margin of -0.75 hr was prespecified. One-hundred and four patients were randomly allocated to fixed continuous positive airway pressure (n = 52) and auto-adjusting positive airway pressure (n = 52) titration. The mean difference and the 95% confidence intervals in continuous positive airway pressure adherence after 3 months between the two arms were 0.80 (-0.08, 1.69) hr. The non-inferiority hypothesis was confirmed as the lower one-sided 97.5% confidence interval for the mean difference was above the prespecified margin. Patients in the fixed continuous positive airway pressure titration arm were titrated at significantly lower pressure level and had a significantly lower amount of average leaks compared with auto-adjusting positive airway pressure-titrated patients, while there was no difference in residual obstructive apnea-hypopnea index on polysomnography. Telemonitoring enables ambulatory continuous positive airway pressure titration with fixed pressure that is non-inferior to ambulatory titration with auto-adjusting pressure in patients with moderate obstructive sleep apnea., (© 2023 European Sleep Research Society.)

It is known that adenosine excess due to monophosphate deaminase deficiency (AMPD1) can be linked to muscle problems. Recently, Perumal et al., 2014 reported a first case of possible impact of AMPD1 on sleep, REM sleep and cholinergic neurotransmission. We report a second patient with similar sleep complaints: long sleep duration with residual daytime sleepiness and a need to sleep after exercise. On polysomnography we observed a long sleep duration, with high sleep efficiency and a SOREMP; on MSLT a shortened sleep latency and 4 SOREMPS were observed. Frequency power spectral heart rate analysis during slow wave sleep, REM sleep and wakefulness revealed an increased parasympathetic tone. In conclusion, AMPD1 could have a profound influence on cholinergic neurotransmission and sleep; further studies are mandatory., (© 2015 The Authors. Journal of Sleep Research published by John Wiley & Sons Ltd on behalf of European Sleep Research Society.)