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Introduction : There are currently only little data available on the factors predicting the respective efficacy of fixed CPAP (FP-CPAP) or automated CPAP (APAP) for OSAS treatment. Aims and objectives : We evaluated the efficacy of a 3month-period treatment with FP-CPAP versus APAP on a composit criteria involving apnoea/ hyponoea index (AHI) and the Epworth score (ESS), according to the level of effective pressure (Peff) as well as pressure variability (Pvar). Methods : A multicenter prospective controlled study was conducted in 22 academic and non academic french centers. Initial clinical and polygraphic data were obtained before initiating a 7-day period using APAP delivering a variable pressure between 4 and 20 cm Hg. Then, patients were randomised to either FP-CPAP or APAP used during 3 months, and the data obtained at the end of the study period were analysed according to the inital level of Peff and Pvar. Results : 616 patients (mean age : 56.8 yrs ± 11.2, mean AHI : 51.7/h ± 20.8) were included. CPAP compliance was the same in both groups (FP-CPAP : 5.78h ± 1.9 vs APAP : 5.85h± 1.9) with an identical efficacy on AHI and the ESS (FP-CPAP : 6.11/h ± 7.94 and 6.02 ± 4.37, and APAP 5.71/h ± 6.75 and 6.05 ± 4.5). Despite the lack of influence of Pvar on FP-CPAP vs APAP efficiency, a greater initial pressure variability was associated with a significant higher residual AHI whatever the mode of CPAP applied. Conclusion : The efficiency of FP-CPAP and APAP was identical on OSAS improvement after 3 months of treatment, independently of initial level of effective pressure and variability.

In order to lower the costs of the diagnosis of sleep apnoea syndrome (SAS), we compared recordings of respiratory polygraphy (RP) and full polysomnography (PSG) and conducted a cost-effectiveness study on recordings in the laboratory and at home. A total of 157 patients referred for investigation of suspected SAS prospectively underwent full PSG using the same equipment (Cidelec 102–108) at home (n=56) or in the laboratory (n=101) according to their wish and physical and mental abilities. The apnoea-hypopnoea index analysed by PSG was higher than that measured by RP analysis (P 10/h, the sensitivity of RP at home and in the laboratory was similar (92.9 % and 85.5 %, respectively). To minimize costs, we propose a two-step diagnostic strategy: RP followed, when negative, by a full PSG. This procedure is cost advantageous when the prevalence of SAS in the sleep clinic is above 45 % at home or 55 % in the laboratory. This strategy could save 35–67 % of the laboratory PSG costs when the prevalence of SAS rises from 45 % to 100 % in the clinic population.

Sleep disorders have a high prevalence: around 20% of insomniacs, 10% hypersomnolent including 2 to 4% of sleep disordered breathing in the general adult population. The low availability of sleep centres implies the research of alternative recording techniques in the natural setting of the patient. The objective was to evaluate an ambulatory recorder and its integration in a managed healthcare network. Fifteen patients had a full set-up at home and ten patients were hooked-up in the hospital but recorded at home. Technical failures occurred in 2/15 with full polysomnographic recordings. Integration within an experimental sleep network is in progress. This managed care network will include training of general practitioners, teletransmissions between GP and sleep specialists for a graded use of available resources including ambulatory monitoring.