Influence of nasal obstruction on auto-CPAP behaviour during sleep in sleep apnoea/hypopnoea syndrome

Background-Auto-CPAP machines have been developed to adapt automatically the positive pressure level to the required needs. The auto-CPAP response to transient nasal obstruction was tested during sleep in patients with sleep apnoea/hypopnoea syndrome (SAHS). Methods-Nasal obstruction was induced by local instillation of histamine. Fourteen nasal challenges were performed on eight patients, seven while the patients were on the "Morphee plus" apparatus and the other seven with the patients on the "Horizon" machine. Results-Nasal resistance increased initially by a mean (SD) of 166 (66)% during the trials with the "Morphee plus" and by 118 (44)% with the "Horizon" machine. The increase in nasal resistance was always accompanied by flow limitation with one exception. Mask pressure initially decreased to the minimal permitted value as nasal resistance increased with the "Morphee plus" device. A late increase of the positive pressure level occurred sometimes. Mask pressure did not change with increasing nasal resistance when the "Horizon" device was used. Conclusion-Neither the "Morphee plus" nor the "Horizon" device abolished flow limited breaths and resulting sleep fragmentation. We conclude that, despite the different algorithm of pressure changes, these auto-CPAP machines do not adequately respond to an acute increase in nasal resistance.