Authors' objectives:

This report is intended to assess the usefulness of outpatient BiPAP in patients with obstructive sleep apnea.

Authors' results and conclusions: Few clinical trials were identified as including information which is significant to this report. All of them compared the use of BiPAP versus continuous positive airway pressure (CPAP) in outpatients. One randomised controlled trial (RCT) was conducted in 27 individuals with obstructive sleep apnea (OSA) during one month. Both treatments reduced the hypopnea-apnea index, showing no differences between both devices. After one month, there were no differences as regards adherence: The percentages of nights where the device was used more than 4 hours were similar as well as the average of total hours (approx. 5 hours per night in both cases). Neither were there differences in the questionaires which assessed other sleeptime aspects. Another study randomized 27 patients with OSA during 6 weeks. This study compared BiPAP with autotitrating positive airway pressure (APAP). Both devices improved those parameters related with shortness of breath and quality of sleeptime, though the use of long-term APAP was preferred (21 versus 5 patients, p<0.05). In 1995, a RCT between BiPAP and CPAP in 83 patients with OSA with one year follow-up did not show benefits of one over the other, thus indicating that patients refered similar rates of malaise. Several health insurance companies consider the use of CPAP as treatment of choice in patients with OSA whose hypopnea-apnea index is higher than 15 and sometimes when it is between 5 and 14. These companies consider BiPAP, among others, as an alternative in case the patient does not tolerate CPAP.

Authors' recommendations: Though it is accepted that the use of positive pressure devices would be the treatment of choice in patients with severe OSA, there is still no concluding evidence of its long-term benefits. These recommendations provided by experts are even weaker when it refers to patients with less severe stages of this pathology. Few are the studies found on the ambulatory use of BiPAP in patients with this pathology. In addition, the studies assessed show poor methodologic quality and scarce number of patients.. The benefits of CPAP are clearly stated, however, the usefulness of BiPAP in this type of patients is not adequately documented. Some health coverages consider it as an alternative when there is not good adherence to CPAP, when concomitant hypoventilation coexists or when desaturation episodes persist despite an adequate adherence to CPAP. However, evidence related to these indications is still limited.

Authors' methods: Overview

Project Status: Completed

URL for project: http://www.iecs.org.ar/

Year Published: 2006

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Argentina

Organisation Name: Institute for Clinical Effectiveness and Health Policy

Contact Address: Dr. Emilio Ravignani 2024, Buenos Aires - Argentina, C1414 CABA

Contact Name: info@iecs.org.ar

Contact Email: info@iecs.org.ar

Copyright: Institute for Clinical Effectiveness and Health Policy (IECS)