Small study: Nasal EPAP plus nonsupine sleep benefits OSA patients

BALTIMORE – A treatment regimen combining nasal expiratory positive airway pressure with sleeping on one’s side can help manage obstructive sleep apnea, even in patients with cardiovascular comorbidities who have failed prior therapies, according to Cleveland researchers.

In a small study of 42 adults who tried this dual therapy for 1 month, 81% achieved good to optimal control of obstructive sleep apnea (OSA) and 92% reported tolerability and compliance with the Provent expiratory positive airway pressure (EPAP) device.

"Generally, continuous positive airway pressure [CPAP] is prescribed as first-line therapy because of its proven effectiveness, however adherence remains low with CPAP, with anywhere from 46% to 83% of patients still nonadherent," said Dr. Mita Deoras of University Hospitals Case Medical Center. Because of this, physicians continue to search for alternate therapies, she said at the annual meeting of the Associated Professional Sleep Societies.

Dr. Deoras and her colleagues have recruited 42 adults with OSA from an independent sleep center starting in 2010. Twenty-five (60%) of the participants were men. The average age was 61 years and the average BMI was 30.9. The majority (76%) had known cardiovascular comorbidities, including diabetes, hypertension, hyperlipidemia, and/or coronary artery disease. Ninety percent (38) had had previous treatment for their OSA, mostly with CPAP but a few with oral appliances, uvulopalatopharyngoplasty, or some combination. Fifteen percent had mild OSA, 42.5% had moderate OSA, 37.5% had severe OSA, and 5% had primary snoring.

"This study has the ability to offer an effective therapeutic option for this very common patient population."

Researchers obtained a baseline apnea-hypopnea index (AHI) from patients’ medical records. After an initial visit, participants were told about EPAP and shown how to use it, then asked to use it for 1 month. They also were asked to sleep in positions other than their backs. After the month, if patients were compliant, they came for a validation polysomnogram in which they stayed overnight at the sleep center while wearing the EPAP device and a cannula to measure nasal flow, and were encouraged to sleep in positions other than their backs.

The majority of patients had an improvement in AHI, with a mean reduction of 22.4. No statistically significant differences in improvement were seen between genders or among varying BMI levels. Sixty percent met the study condition for optimal control of OSA, defined as an AHI less than 5, and 20% met the definition of good control of OSA, defined as an AHI of 10 or less. Patients also reported a reduction in daytime sleepiness; the average Epworth Sleepiness Scale rating declined from 9.8 at baseline to 7.6.

"While we know that nasal EPAP is FDA approved for the treatment of OSA, clinicians are still often cautious against using it in patients with severe OSA or significant comorbidities," she said. And while sleep repositioning "can be as effective as CPAP in patients with position-dependent OSA, it isn’t often recommended as a first-line therapy.... This study has the ability to offer an effective therapeutic option for this very common patient population."

Study contributors were from MetroHealth Medical Center, the Cleveland Clinic Foundation, and Northcoast Clinical Trials Sleep Center. The study was funded by University Hospitals Case Medical Center. The researchers reported having no financial conflicts.

BALTIMORE – A treatment regimen combining nasal expiratory positive airway pressure with sleeping on one’s side can help manage obstructive sleep apnea, even in patients with cardiovascular comorbidities who have failed prior therapies, according to Cleveland researchers.

In a small study of 42 adults who tried this dual therapy for 1 month, 81% achieved good to optimal control of obstructive sleep apnea (OSA) and 92% reported tolerability and compliance with the Provent expiratory positive airway pressure (EPAP) device.

"Generally, continuous positive airway pressure [CPAP] is prescribed as first-line therapy because of its proven effectiveness, however adherence remains low with CPAP, with anywhere from 46% to 83% of patients still nonadherent," said Dr. Mita Deoras of University Hospitals Case Medical Center. Because of this, physicians continue to search for alternate therapies, she said at the annual meeting of the Associated Professional Sleep Societies.

Dr. Deoras and her colleagues have recruited 42 adults with OSA from an independent sleep center starting in 2010. Twenty-five (60%) of the participants were men. The average age was 61 years and the average BMI was 30.9. The majority (76%) had known cardiovascular comorbidities, including diabetes, hypertension, hyperlipidemia, and/or coronary artery disease. Ninety percent (38) had had previous treatment for their OSA, mostly with CPAP but a few with oral appliances, uvulopalatopharyngoplasty, or some combination. Fifteen percent had mild OSA, 42.5% had moderate OSA, 37.5% had severe OSA, and 5% had primary snoring.

"This study has the ability to offer an effective therapeutic option for this very common patient population."

Researchers obtained a baseline apnea-hypopnea index (AHI) from patients’ medical records. After an initial visit, participants were told about EPAP and shown how to use it, then asked to use it for 1 month. They also were asked to sleep in positions other than their backs. After the month, if patients were compliant, they came for a validation polysomnogram in which they stayed overnight at the sleep center while wearing the EPAP device and a cannula to measure nasal flow, and were encouraged to sleep in positions other than their backs.

The majority of patients had an improvement in AHI, with a mean reduction of 22.4. No statistically significant differences in improvement were seen between genders or among varying BMI levels. Sixty percent met the study condition for optimal control of OSA, defined as an AHI less than 5, and 20% met the definition of good control of OSA, defined as an AHI of 10 or less. Patients also reported a reduction in daytime sleepiness; the average Epworth Sleepiness Scale rating declined from 9.8 at baseline to 7.6.

"While we know that nasal EPAP is FDA approved for the treatment of OSA, clinicians are still often cautious against using it in patients with severe OSA or significant comorbidities," she said. And while sleep repositioning "can be as effective as CPAP in patients with position-dependent OSA, it isn’t often recommended as a first-line therapy.... This study has the ability to offer an effective therapeutic option for this very common patient population."

Study contributors were from MetroHealth Medical Center, the Cleveland Clinic Foundation, and Northcoast Clinical Trials Sleep Center. The study was funded by University Hospitals Case Medical Center. The researchers reported having no financial conflicts.

BALTIMORE – A treatment regimen combining nasal expiratory positive airway pressure with sleeping on one’s side can help manage obstructive sleep apnea, even in patients with cardiovascular comorbidities who have failed prior therapies, according to Cleveland researchers.

In a small study of 42 adults who tried this dual therapy for 1 month, 81% achieved good to optimal control of obstructive sleep apnea (OSA) and 92% reported tolerability and compliance with the Provent expiratory positive airway pressure (EPAP) device.

"Generally, continuous positive airway pressure [CPAP] is prescribed as first-line therapy because of its proven effectiveness, however adherence remains low with CPAP, with anywhere from 46% to 83% of patients still nonadherent," said Dr. Mita Deoras of University Hospitals Case Medical Center. Because of this, physicians continue to search for alternate therapies, she said at the annual meeting of the Associated Professional Sleep Societies.

Dr. Deoras and her colleagues have recruited 42 adults with OSA from an independent sleep center starting in 2010. Twenty-five (60%) of the participants were men. The average age was 61 years and the average BMI was 30.9. The majority (76%) had known cardiovascular comorbidities, including diabetes, hypertension, hyperlipidemia, and/or coronary artery disease. Ninety percent (38) had had previous treatment for their OSA, mostly with CPAP but a few with oral appliances, uvulopalatopharyngoplasty, or some combination. Fifteen percent had mild OSA, 42.5% had moderate OSA, 37.5% had severe OSA, and 5% had primary snoring.

"This study has the ability to offer an effective therapeutic option for this very common patient population."

Researchers obtained a baseline apnea-hypopnea index (AHI) from patients’ medical records. After an initial visit, participants were told about EPAP and shown how to use it, then asked to use it for 1 month. They also were asked to sleep in positions other than their backs. After the month, if patients were compliant, they came for a validation polysomnogram in which they stayed overnight at the sleep center while wearing the EPAP device and a cannula to measure nasal flow, and were encouraged to sleep in positions other than their backs.

The majority of patients had an improvement in AHI, with a mean reduction of 22.4. No statistically significant differences in improvement were seen between genders or among varying BMI levels. Sixty percent met the study condition for optimal control of OSA, defined as an AHI less than 5, and 20% met the definition of good control of OSA, defined as an AHI of 10 or less. Patients also reported a reduction in daytime sleepiness; the average Epworth Sleepiness Scale rating declined from 9.8 at baseline to 7.6.

"While we know that nasal EPAP is FDA approved for the treatment of OSA, clinicians are still often cautious against using it in patients with severe OSA or significant comorbidities," she said. And while sleep repositioning "can be as effective as CPAP in patients with position-dependent OSA, it isn’t often recommended as a first-line therapy.... This study has the ability to offer an effective therapeutic option for this very common patient population."

Study contributors were from MetroHealth Medical Center, the Cleveland Clinic Foundation, and Northcoast Clinical Trials Sleep Center. The study was funded by University Hospitals Case Medical Center. The researchers reported having no financial conflicts.