Journal article
Treating chronic hypoventilation with automatic adjustable versus fixed EPAP Intelligent Volume-Assured Positive Airway Pressure Support (iVAPS): A randomized controlled trial
Sleep (New York, N.Y.), Vol.40(10)
2017
PMID: 28958052
Abstract
Objectives
New noninvasive ventilation (NIV) modes can automatically adjust pressure support settings to deliver effective ventilation in response to varying ventilation demands. It is recommended that fixed expiratory positive airway pressure (FixedEPAP) is determined by attended laboratory polysomnographic (PSG) titration. This study investigated whether automatically determined EPAP (AutoEPAP) was noninferior to FixedEPAP for the control of obstructive sleep apnea (OSA) during intelligent volume-assured pressure support (iVAPS) treatment of chronic hypoventilation.
Methods
In this randomized, double-blind, crossover study, patients with chronic hypoventilation and OSA used iVAPS with AutoEPAP or FixedEPAP over two separate nights of attended PSG. PSG recordings were scored by an independent scorer using American Academy of Sleep Medicine 2012 criteria.
Results
Twenty-five adults (14 male) with chronic hypoventilation secondary to obesity hypoventilation syndrome (n = 11), chronic obstructive pulmonary disease (n = 9), or neuromuscular disease (n = 5), all of whom were on established home NIV therapy, were included (age 57 ± 7 years, NIV for ≥3 months, apnea-hypopnea index [AHI] >5/hour). AutoEPAP was noninferior to FixedEPAP for the primary outcome measure (median [interquartile range] AHI 2.70 [1.70–6.05]/hour vs. 2.40 [0.25–5.95]/hour; p = .86). There were no significant between-mode differences in PSG sleep breathing and sleep quality, or self-reported sleep quality, device comfort, and patient preference. Mean EPAP with the Auto and Fixed modes was 10.8 ± 2.0 and 11.8 ± 3.9 cmH2O, respectively (p = .15).
Conclusions
In patients with chronic hypoventilation using iVAPS, the AutoEPAP algorithm was noninferior to FixedEPAP over a single night’s therapy.
Details
- Title
- Treating chronic hypoventilation with automatic adjustable versus fixed EPAP Intelligent Volume-Assured Positive Airway Pressure Support (iVAPS): A randomized controlled trial
- Authors/Creators
- Nigel McArdle - The University of Western AustraliaClare Rea - West Australian Sleep Disorders Research InstituteStuart King - The University of Western AustraliaKathleen Maddison - The University of Western AustraliaDinesh Ramanan - ResMed (Australia)Sahisha Ketheeswaran - ResMed (Australia)Lisa Erikli - ResMed (Australia)Vanessa Baker - The University of Western AustraliaJeff Armitstead - ResMed (Australia)Glenn Richards - ResMed (Australia)Bhajan Singh - The University of Western AustraliaDavid Hillman - The University of Western AustraliaPeter Eastwood - West Australian Sleep Disorders Research Institute
- Publication Details
- Sleep (New York, N.Y.), Vol.40(10)
- Publisher
- Oxford Univ Press
- Number of pages
- 9
- Grant note
- ResMed Ltd (Bella Vista, Sydney, Australia)
- Identifiers
- 991005592761307891
- Copyright
- © Sleep Research Society 2017
- Murdoch Affiliation
- Vice Chancellery
- Language
- English
- Resource Type
- Journal article
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- Industry collaboration
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- Citation topics
- 1 Clinical & Life Sciences
- 1.137 Sleep Science & Circadian Systems
- 1.137.382 Obstructive Sleep Apnea
- Web Of Science research areas
- Clinical Neurology
- Neurosciences
- ESI research areas
- Neuroscience & Behavior