Fixed-pressure versus auto-adjusting continuous positive airway pressure for blood pressure control in obstructive sleep apnoea: a double-blind, randomised, crossover trial (FIX PAP Trial ).
rct · Level II
Where this comes from
- Record sourced from PubMed, PMID 41933609.
- Also identified by DOI 10.1016/j.chest.2026.03.019.
- No licence information is recorded for this record.
- Because redistribution is not established, this page shows the abstract only. Follow the links below for the full text.
Abstract
Limited data exist concerning the impact of fixed-pressure PAP (FPAP) and auto-adjusting CPAP (APAP) on blood pressure (BP) in patients with obstructive sleep apnoea (OSA). In hypertensive patients with OSA, do FPAP and APAP lead to different effects on blood pressure? In this double-blind, randomised crossover clinical trial, patients with OSA and hypertension were treated with both FPAP and APAP. Ambulatory blood pressure monitoring (ABPM) and autonomic function testing were performed before and after each treatment. The effect of PAP mode on the change from baseline (4-week value minus baseline value) was analysed using a Bayesian hierarchical linear model. Forty-six patients (mean age 48.8±11.2 years) with OSA (median AHI 59 [IQR: 34, 99] events/hour) were enrolled, with 30 patients completing both treatment arms. Median device use was 6.2 hours/night. In the primary Bayesian hierarchical analysis, FPAP showed a high probability of superior Systolic Blood Pressure (SBP) control compared to APAP. For 24-hour SBP, the posterior median treatment effect was -4.41 mmHg [95% CrI: -11.11, 2.00] with a Probability of Direction (pd) of 91.2%. This effect was more pronounced for nighttime SBP, with a posterior median change of -6.80 mmHg [95% CrI: -15.37, 1.76] and a pd of 94.0%. FPAP increased the likelihood of nocturnal diastolic BP dipping compared with APAP (posterior probability of benefit 94.3%; OR 4.09).Baseline characteristics, compliance, and satisfaction were similar between treatment sequences (pd typically < 75%). Mean FPAP pressure was higher than APAP (P95) pressures (12.51±4.55 vs. 10.33±2.66 cmH<sub>2</sub>O). Our analysis suggests a high probability that FPAP provides superior BP control compared to APAP in OSA patients with Hypertension. These findings challenge the assumption that APAP provides equivalent cardiovascular protection and suggest that fixed-pressure therapy, guided by manual titration, may be preferable for optimal blood pressure management in this population.