A Randomized, Double-blind Clinical Trial Comparing Continuous Positive Airway Pressure with a Novel Bilevel Pressure System for Treatment of Obstructive Sleep Apnea Syndrome

Herold, Daniel L.; Olson, Eric J.

doi:10.1093/sleep/26.7.864

Cited by 82 publications

(71 citation statements)

References 36 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…High adherence rates across the sample have been reported in other studies which have attempted to initiate a comparison of devices at the beginning of therapy. 9,16 Based on our experiences as well as previous report, 4 we had anticipated fairly poor adherence among patients who had a poor initial CPAP experience. The cumulative benefit of participating in the trial may have improved population adherence rates by providing intense support and maintenance of the therapy, along with proper mask adjustments and humidification.…”

Section: Discussionmentioning

confidence: 63%

“…4 Previous studies have attempted to either demonstrate improvement in adherence by early interventions or the use of variable pressure devices. Other studies attempting to utilize novel therapies at initiation of treatment have also failed to demonstrate clinically significant improvements in adherence rates compared to CPAP 9,17 ; despite some preference differences, most studies using bilevel devices also fail to demonstrate different clinically significant usage patterns. [5][6][7][8] Comparable to these studies, our study failed to demonstrate a significant improvement in adherence rates, regardless of improved daytime functioning and functional outcomes.…”

Section: Subjective Estimatesmentioning

confidence: 99%

“…A randomized trial demonstrated equivalent adherence compared with standard CPAP in the initial treatment of OSA, as well as comparable effi cacy. 9 Another large study assessing existing non-adherent users after more than 9 months of therapy and an additional 2 weeks of standard interventions demonstrated signifi cantly greater adherence rates using a fl exible bilevel pressure device compared to standard CPAP therapy. 10 Based on the notion that early treatment usage predicts sustained adherence, we sought to determine whether an alternaBRIEf SUMMARY Current Knowledge/Study Rationale: Despite the challenges by clinicians to maintain adequate treatment adherence, nasal CPAP therapy continues to be the primary treatment option for obstructive sleep apnea (OSA).…”

mentioning

confidence: 99%

See 2 more Smart Citations

A Pilot Study Assessing Adherence to Auto-Bilevel Following a Poor Initial Encounter with CPAP

Powell

Ojile²,

Litinski³

et al. 2012

Journal of Clinical Sleep Medicine

Self Cite

View full text Add to dashboard Cite

Study Objectives: We hypothesized that early intervention with an auto bilevel device would improve treatment adherence compared to CPAP among OSA patients with a poor initial experience with lab-based CPAP titration. Methods: Patients with a poor initial CPAP experience were recruited for this parallel group, randomized, double-blind, controlled pilot study. After an in-lab titration, patients were randomized with either an auto-bilevel device or CPAP. Treatment adherence and functioning were assessed at 90 days. Results: We enrolled 51 subjects, with 47 completing the protocol. Groups were equally matched for gender, age, education, and OSA severity. There was no signifi cant difference in the proportion of compliant subjects (≥ 4 h/night) between the auto bilevel and CPAP groups (62% vs. 54%; p = 0.624) after 90 days of use. Functional outcomes signifi cantly improved in both groups during treatment use (p < 0.001) but did not differ between groups. Conclusions: There was no statistically signifi cant difference in adherence between the auto bilevel and CPAP groups in this study. Patients with a poor initial CPAP exposure may still achieve an acceptable long-term clinical outcome. Both groups demonstrated comparably signifi cant improvements in functional outcomes, sleepiness, and fatigue complaints over the treatment period. Clinical Trials Information: NCT00635206 ClinicalTrials.gov Keywords: Treatment compliance, obstructive sleep apnea, continuous positive airway pressure, bilevel positive airway pressure, lung Citation: Powell ED; Gay PC; Ojile JM; Litinski M; Malhotra A. A pilot study assessing adherence to auto-bilevel following a poor initial encounter with CPAP.

show abstract

Section: Discussionmentioning

confidence: 63%

Section: Subjective Estimatesmentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

A Pilot Study Assessing Adherence to Auto-Bilevel Following a Poor Initial Encounter with CPAP

Powell

Ojile²,

Litinski³

et al. 2012

Journal of Clinical Sleep Medicine

Self Cite

View full text Add to dashboard Cite

show abstract

“…In CPAP/BPAP adherence studies, [33][34][35] the machine mode has been thought to affect adherence. We found that the percentages of subjects using BPAP in the adherent and non-adherent groups were similar (15% and 16%, respectively), so we conclude that machine mode did not affect adherence.…”

Section: Discussionmentioning

confidence: 99%

CPAP Adherence of Patients With Obstructive Sleep Apnea

et al. 2013

View full text Add to dashboard Cite

BACKGROUND: Continuous positive airway pressure (CPAP) and bi-level positive airway pressure (BPAP) are the gold standard treatments for obstructive sleep apnea syndrome (OSAS), but CPAP/BPAP is not well tolerated and requires long-term follow-up. OBJECTIVE: We prospectively assessed subjective and objective adherence and factors that affect adherence in OSAS patients. METHODS: Subjects using CPAP/BPAP were questioned about adverse effects of CPAP/ BPAP and were assessed with the Epworth Sleepiness Scale (ESS) at the first, third, sixth, and twelfth month, and once every 6 months after the first year. CPAP/BPAP use and objective and subjective adherence were assessed. Subjects who used CPAP/BPAP for at least 4 hours per night for at least 70% of the days monitored were regarded as adherent, and those who did not were considered non-adherent. The relationships between adherence and demographic data, polysomnography findings, ESS scores, and adverse effects were statistically analyzed. RESULTS: Sixhundred forty-eight subjects who were diagnosed with OSAS by polysomnography and accepted to use CPAP/BPAP in our sleep center between January 2005 and June 2011 were included. Fourhundred fifty-one subjects (69.6%) were men, and 197 (30.4%) were women. Two-hundred fortyeight (38.3%) subjects attended follow-ups, 246 (37.9%) were called by telephone, and 154 (23.8%) could not be reached. Of the whole population, 63.9% had obtained their CPAP/BPAP machine. In the 248 subjects who attended follow-ups, subjective adherence was 85.1% and objective adherence was 64.5%. Improvement in ESS score (P < .001) and satisfactory sleep (P < .001) were found to be significantly higher in the adherent group. Chest discomfort, difficulty falling asleep, and sleep disturbances were significantly higher in the non-adherent group (all P < .01). CONCLUSIONS: Of the whole population, just 38.3% attended follow-ups. The objective adherence was lower than the subjective adherence in subjects who attended follow-ups. Younger subjects were more adherent, and the most important factors that correlated with adherence were substantial improvement of daytime sleepiness and effect of CPAP/BPAP on satisfactory sleep. CONCLUSIONS: CPAP/ BPAP adherence should be followed with objective monitoring.

show abstract

“…Bilevel positive airway pressure (PAP) devices allow for separate inspiratory and expiratory pressure settings that may be more comfortable for some patients. Although studies have not shown improvements in adherence, 44 select patients seem to tolerate bilevel PAP better than CPAP, particularly when high pressures are required or if patients had a prolonged period of poor initial tolerance to CPAP treatment. 45 In fact, AASM suggests bilevel PAP be used when CPAP pressure exceeds 15 cm H 2 O.…”

Section: Treatment Optionsmentioning

confidence: 91%

Updates on Definition, Consequences, and Management of Obstructive Sleep Apnea

Park

Ramar

Olson

2011

Mayo Clinic Proceedings

Self Cite

363

236

View full text Add to dashboard Cite

Obstructive sleep apnea (OSA) is a breathing disorder during sleep that has implications beyond disrupted sleep. It is increasingly recognized as an independent risk factor for cardiac, neurologic, and perioperative morbidities. Yet this disorder remains undiagnosed in a substantial portion of our population. It is imperative for all physicians to remain vigilant in identifying patients with signs and symptoms consistent with OSA. This review focuses on updates in the areas of terminology and testing, complications of untreated OSA, perioperative considerations, treatment options, and new developments in this field. Mayo Clin

show abstract

A Randomized, Double-blind Clinical Trial Comparing Continuous Positive Airway Pressure with a Novel Bilevel Pressure System for Treatment of Obstructive Sleep Apnea Syndrome

Abstract: The NBL appeared to be as effective as CPAP for the treatment of OSAS but offered no advantages in patients receiving first-time therapy for OSAS.

Cited by 82 publications

References 36 publications

A Pilot Study Assessing Adherence to Auto-Bilevel Following a Poor Initial Encounter with CPAP

A Pilot Study Assessing Adherence to Auto-Bilevel Following a Poor Initial Encounter with CPAP

CPAP Adherence of Patients With Obstructive Sleep Apnea

Updates on Definition, Consequences, and Management of Obstructive Sleep Apnea

Contact Info

Product

Resources

About