Efficacy of Bilevel-auto Treatment in Patients with Obstructive Sleep Apnea Not Responsive to or Intolerant of Continuous Positive Airway Pressure Ventilation

Abstract

Background: Ventilation with continuous positive airway pressure (CPAP) is the gold standard therapy for obstructive sleep apnea (OSA). However, it was recently suggested that a novel mode of ventilation, Bilevel-auto, could be equally effective in treating patients unable to tolerate CPAP. The aim of this study was to investigate the ability of Bilevel-auto to treat OSA patients whose nocturnal ventilatory disturbances are not completely corrected by CPAP. Methods: We enrolled 66 consecutive OSA patients, not responsive to (group A) or intolerant of (group B) CPAP treatment, after a full night of manual CPAP titration in a laboratory. Full polysomnography data and daytime sleepiness score were compared for each group in the three different conditions: basal, during CPAP, and during Bilevel-auto. Results: The apnea-hypopnea index decreased signifi cantly during CPAP in both groups; however, in the group A, there was a further signifi cant improvement during Bilevel-auto.The same trend was observed for oxygenation indices, while the distribution and the effi ciency of sleep did not differ following the switch from CPAP to Bilevel-auto. Conclusions: This study confi rmed the role of Bilevel-auto as an effective therapeutic alternative to CPAP in patients intolerant of this latter mode of ventilation. Moreover, extending the use of Bilevel-auto to those OSA patients not responsive to CPAP, we showed a signifi cantly better correction of nocturnal respiratory disturbances.

Severity of nocturnal hypoxia and daytime hypercapnia predicts CPAP failure in patients with COPD and obstructive sleep apnea overlap syndrome

“…On the other hand, the role of BiPAP was recently highlighted as an effective therapeutic alternative to CPAP in patients with OSA who do not tolerate CPAP [5]. Nevertheless, factors that are associated with primary failure with the initial CPAP therapy in patients with the OSA-COPD overlap syndrome remain unknown.…”

Practical Recommendations of the Obesity Management Task Force of the European Association for the Study of Obesity for the Post-Bariatric Surgery Medical Management

“…These patients suffer from a COPD-OSA overlap syndrome and may benefit from bi-level positive airway pressure (BiPAP) treatment [57]. BiPAP treatment might also an effective therapeutic alternative for CPAP in patients not responsive or intolerant to CPAP [58]. In patients with obesity, weight loss is the most important alternative treatment for OSA.…”

Sleep Apnea – Recent Updates

“…These have included auto-bi-level pressure relief-positive airway pressure (ABPR-PAP). Four studies [64][65][66][67] showed similar improvements in symptoms using an auto-bi-level mode and CPAP. Compliance was generally beter with the auto-bi-level modes than CPAP, even in CPAP patients selected for poor compliance [65,67].…”