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.

Content Provider	Europe PMC
Author	Palot, Alain Nguyên, Xuân-Lan Launois, Sandrine Prigent, Arnaud Graml, Andrea Aversenq, Elodie Koltes, Christian Recart, Didier Lavergne, Florent
Copyright Year	2023
Abstract	BackgroundIssues 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 patient-reported outcomes in patients with obstructive sleep apnea (OSA).MethodsEligible 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.ResultsForty patients were analyzed (68% male, age 64±11 years, body mass index 30.7±5.8 kg/m2). 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 PAP {from 12 [11–13] to 8 [7–9] cmH2O at 3 months (P<0.001) and 9 [8–12] cmH2O at 1 year (P=0.005)}, 95th percentile pressure {from 14 [12–14] to 10 [9–11] and 10 [8–11] cmH2O; P<0.001 and P=0.001, respectively} and leak {from 1 [0–6] 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.ConclusionsSwitching to bilevel PAP had several benefits in patients struggling with CPAP, facilitating therapy acceptance and ongoing device usage.
ISSN	20721439
Journal	Journal of Thoracic Disease
Volume Number	15
PubMed Central reference number	PMC9992565
Issue Number	2
PubMed reference number	36910096
e-ISSN	20776624
DOI	10.21037/jtd-22-825
Language	English
Publisher	AME Publishing Company
Publisher Date	2023-01-14
Access Restriction	Open
Rights License	Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0. 2023 Journal of Thoracic Disease. All rights reserved.
Subject Keyword	Positive airway pressure (PAP) obstructive sleep apnea (OSA) sleep quality patient reported outcomes daytime sleepiness patient preference
Content Type	Text
Resource Type	Article
Subject	Pulmonary and Respiratory Medicine