AVAPS‐AE versus ST mode: A randomized controlled trial in patients with obesity hypoventilation syndrome

Abstract

Background and objective Average volume‐assured pressure support—automated expiratory positive airway pressure (AVAPS‐AE) combines an automated positive expiratory pressure to maintain upper airway patency to an automated pressure support with a targeted tidal volume. The aim of this study was to compare the effects of 2‐month AVAPS‐AE ventilation versus pressure support (ST) ventilation on objective sleep quality in stable patients with OHS. Secondary outcomes included arterial blood gases, health‐related quality of life, daytime sleepiness, subjective sleep quality and compliance to NIV. Methods This is a prospective multicentric randomized controlled trial. Consecutive OHS patients included had daytime PaCO2 > 6 kPa, BMI ≥ 30 kg/m2, clinical stability for more than 2 weeks and were naive from home NIV. PSG were analysed centrally by two independent experts. Primary endpoint was sleep quality improvement at 2 months. Results Among 69 trial patients, 60 patients had successful NIV setup. Baseline and follow‐up PSG were available for 26 patients randomized in the ST group and 30 in the AVAPS‐AE group. At baseline, PaCO2 was 6.94 ± 0.71 kPa in the ST group and 6.61 ± 0.71 in the AVAPS‐AE group (P = 0.032). No significant between‐group difference was observed for objective sleep quality indices. Improvement in PaCO2 was similar between groups with a mean reduction of −0.87 kPa (95% CI: −1.12 to −0.46) in the ST group versus −0.87 kPa (95% CI: −1.14 to −0.50) in the AVAPS‐AE group (P = 0.984). Mean NIV use was 6.2 h per night in both groups (P = 0.93). NIV setup duration was shorter in the AVAPS‐AE group (P = 0.012). Conclusion AVAPS‐AE and ST ventilation for 2 months had similar impact on sleep quality and gas exchange.

Automated ventilator technology: More answers and some questions

“…To the Editors: We have read with interest the recently published editorial by Joosten et al 1 in Respirology, concerning the trial published by Patout et al which compared an automated mode (AVAPS-AE TM ) with a standard non-invasive ventilation (NIV) mode. 2 We agree with the authors concerning the modest interest of those automated modes and on the lack of evidence for their use as first intention treatment in patients needing NIV.…”

Defining successful non‐invasive ventilation initiation: Data from a real‐life cohort

“…These patient-centred outcomes are particularly relevant in these patients who have a poor prognosis 11 and have NIV that can worsen their HRQL. 12 Several strategies such as polysomnographic titration 13 and automated NIV modes 14,15 have been assessed to improve HRQL and sleep quality, without success.…”

Long-Term Mechanical Ventilation: Recommendations of the Swiss Society of Pulmonology

“…These modes are the result of a very sophisticated engineering and technical research. They are not however “fail-safe.” None of these options has, to date, been proven superior to conventional titration of bi-level PPV [28, 32, 34-40]. They are at best “non-inferior” to individually titrated settings.…”