A Randomized Crossover Trial Comparing Autotitrating and Continuous Positive Airway Pressure in Subjects With Symptoms of Aerophagia: Effects on Compliance and Subjective Symptoms

Abstract

Study Objectives: To assess the benefit and tolerance of autotitrating positive airway pressure (APAP) versus continuous positive airway pressure (CPAP) in subjects who experience aerophagia. Methods: This is the report of a prospective, two-week, double-blinded, randomized crossover trial set in an Australian clinical sleep laboratory in a tertiary hospital. Fifty-six subjects who reported symptoms of aerophagia that they attributed to CPAP were recruited. Full face masks were used by 39 of the 56 subjects recruited. Subjects were randomly and blindly allocated to either CPAP at their treatment recommended pressure or APAP 6-20 cm H2O, in random order. Subjects spent two weeks on each therapy mode. Therapy usage hours, 95th centile pressure, maximum pressure, 95th centile leak, and residual apnea-hypopnea index (AHI) were reported at the end of each two-week treatment period. Functional Outcome of Sleepiness Questionnaire, Epworth Sleepiness Scale, and visual analog scale to measure symptoms of aerophagia were also completed at the end of each 2-week treatment arm. Results: The median pressure (P < .001) and 95th centile pressure (P < .001) were reduced with APAP but no differences in compliance (P = .120) and residual AHI were observed. APAP reduced the symptoms of bloating (P = .011), worst episode of bloating (P = .040), flatulence (P = .010), and belching (P = .001) compared to CPAP. There were no differences in Epworth Sleepiness Scale or Functional Outcome of Sleepiness Questionnaire outcomes between CPAP and APAP.

The Importance of Mask Selection on Continuous Positive Airway Pressure Outcomes for Obstructive Sleep Apnea. An Official American Thoracic Society Workshop Report

“…Adaptive servo ventilation may improve positive airway pressure (PAP) adherence among patients with persistent or treatment-emergent central sleep apnea ( 46 ). Aerophagia is more common with oronasal CPAP than with nasal CPAP ( 47 ). Among patients on an oronasal mask who report aerophagia, switching to a nasal mask should be considered.…”

Obstructive sleep apnoea in patients with fibrotic diffuse parenchymal lung disease—characterization and treatment compliance assessment

“…The good compliance in this study group was possible due to a well-organized sleep clinic that was able to deal with and to overcome difficult cases. Furthermore, APAP treatment may be more comfortable for patients than CPAP treatment as reported previously [ 33 ].…”

Complications and safe prescription of interventions for adult sleep disordered breathing in Australia

“…Ulceration as a result of CPAP across the nasal bridge (13) can cause skin necrosis and infection, potentially leading to peri-orbital cellulitis and intracranial complications. Aerophagia to the extent of intense small and large bowel trapping has been documented (14).…”