Effect of switching from continuous to bilevel positive airway pressure on sleep quality in patients with obstructive sleep apnea: the prospective POP IN VAuto study

Abstract

Background: Issues with tolerability and side effects can decrease continuous positive airway pressure (CPAP) device usage and the benefits of therapy. Different positive airway pressure (PAP) therapy modes providing expiratory pressure relief or using a different pressure during inspiration vs. expiration (bilevel PAP) may alleviate some of these issues. This multicenter, prospective study evaluated the effects of switching from CPAP to bilevel PAP (VAuto mode) on respiratory parameters, device usage, side effects and patientreported outcomes in patients with obstructive sleep apnea (OSA).Methods: Eligible OSA patients had started CPAP ≥3 months previously, had good compliance (mean 6.1±2.0 h/night) and well-controlled OSA [residual apnea-hypopnea index (AHI) 4.9±3.1/h] but had pressure tolerance issues or persistent side effects/discomfort. All were switched from CPAP to bilevel PAP (AirCurve 10 VAuto; ResMed). Effectiveness (residual AHI), sleep quality, daytime sleepiness, fatigue, therapy-related side effects, and patient satisfaction/preference were assessed after 3 months and 1 year.Results: Forty patients were analyzed (68% male, age 64±11 years, body mass index 30.7±5.8 kg/m 2 ). At 3 months and 1 year after switching to bilevel PAP, median [interquartile range] residual AHI was 4/h [2-5.3] and 3.7/h [1.8-5], respectively, and device usage was 7.0 [4.9-7.5] and 6.4 [4.4-7.3] h/night, respectively.Device switch was associated with significant reductions from baseline in expiratory to 8 [7-9] cmH 2 O at 3 months (P<0.001) and 9 [8-12] cmH 2 O at 1 year (P=0.005)}, 95 th percentile pressure {from 14 [12][13][14] to 10 [9-11] and 10 [8-11] cmH2O; P<0.001 and P=0.001, respectively} and leak {from 1 [0][1][2][3][4][5][6] to 0 [0-1] and 0 [0-2] L/min; P=0.049 and P=0.033, respectively}. The Pittsburgh Sleep Quality Index score decreased significantly from baseline to 3 and 6 months [7.2±4.0 to 5.0±3.2 (P=0.005) and 4.5±2.7 (P<0.001), respectively]. CPAP-related mouth dryness, choking sensation and aerophagia were significantly improved one year after switching to bilevel PAP. Bilevel PAP was preferred over CPAP by 90% of patients.Conclusions: Switching to bilevel PAP had several benefits in patients struggling with CPAP, facilitating therapy acceptance and ongoing device usage.

Effects of gabapentin on slow‐wave sleep period in critically ill adult patients: A randomized controlled trial

“…Six were weaned from MV to BiPAP on day 4, which might have negatively impacted their sleep, due to changes in airflow, mask discomfort, or adjustment difficulties. 36 However, in the subgroup of patients with MV, SWS increased to an hour on days 3 and 5 in the gabapentin group. Our study revealed that SWS as a primary outcome was significantly increased in ICU patients who received gabapentin.…”

“…This might be because only 15 patients (50% from the beginning) in the gabapentin group were in the ICU until day 5. Six were weaned from MV to BiPAP on day 4, which might have negatively impacted their sleep, due to changes in airflow, mask discomfort, or adjustment difficulties 36 . However, in the subgroup of patients with MV, SWS increased to an hour on days 3 and 5 in the gabapentin group.…”

Sleep Disorders in Neuromuscular Diseases: A Narrative Review

“…Noninvasive positive pressure ventilation (NIV or NPPV, respectively) is indicated for treatment of CSA and NH but is also a recognized therapeutic option for OSA if CPAP is not tolerated or fails to be effective [89,100,112]. Several criteria have been introduced for indication of NIV in patients with NMDs or thoracic wall disease, all including the presence of NHrelated complaints or clinical symptoms of respiratory muscle weakness [100,101,[113][114][115].…”