Nasal Expiratory Positive Airway Pressure Devices (Provent) for OSA: A Systematic Review and Meta-Analysis

Abstract

Objective. To quantify the effectiveness of nasal expiratory positive airway pressure (nasal EPAP) devices or Provent as treatment for obstructive sleep apnea (OSA). Methods. PubMed and six other databases were searched through November 15, 2015, without language limitations. Results. Eighteen studies (920 patients) were included. Pre- and post-nasal EPAP means ± standard deviations (M ± SD) for apnea-hypopnea index (AHI) in 345 patients decreased from 27.32 ± 22.24 to 12.78 ± 16.89 events/hr (relative reduction = 53.2%). Random effects modeling mean difference (MD) was −14.78 events/hr [95% CI −19.12, −10.45], p value < 0.00001. Oxygen desaturation index (ODI) in 247 patients decreased from 21.2 ± 19.3 to 12.4 ± 14.1 events/hr (relative reduction = 41.5%, p value < 0.00001). Lowest oxygen saturation (LSAT) M ± SD improved in 146 patients from 83.2 ± 6.8% to 86.2 ± 11.1%, MD 3 oxygen saturation points [95% CI 0.57, 5.63]. Epworth Sleepiness Scale (ESS) M ± SD improved (359 patients) from 9.9 ± 5.3 to 7.4 ± 5.0, MD −2.5 [95% CI −3.2, −1.8], p value < 0.0001. Conclusion. Nasal EPAP (Provent) reduced AHI by 53.2%, ODI by 41.5% and improved LSAT by 3 oxygen saturation points. Generally, there were no clear characteristics (demographic factors, medical history, and/or physical exam finding) that predicted favorable response to these devices. However, limited evidence suggests that high nasal resistance could be associated with treatment failure. Additional studies are needed to identify demographic and polysomnographic characteristics that would predict therapeutic success with nasal EPAP (Provent).

Palatal prolapse as a signature of expiratory flow limitation and inspiratory palatal collapse in patients with obstructive sleep apnoea

“…Further studies are need to test whether the EFLI can help identify patients who respond to specific therapies, such as uvulopalatopharyngoplasty(40, 41), added nasal expiratory resistance therapy (Provent) (42), expiratory positive airway pressure (EPAP)(12, 13), mandibular advancement devices(43), positional therapy(44, 45), and upper airway stimulation therapy (46, 47). Our results show that palatal prolapse is more frequent in the supine than the lateral position.…”

Nasal Dilators (Breathe Right Strips and NoZovent) for Snoring and OSA: A Systematic Review and Meta-Analysis

“…There are many treatments for OSA, to include medical management with positive airway pressure devices [4], oral appliances, and myofunctional therapy [5]. Nasal therapies to help treat OSA include nasopharyngeal airway stenting devices [6], nasal expiratory positive airway pressure devices (Provent) [7], and nasal surgery [8, 9]. …”

Sleep disordered breathing: management update

“…The self‐generated increase in EPAP provides a pneumatic splint to prevent upper airway collapse, in a similar manner to CPAP. Nasal EPAP devices are effective in reducing the AHI, ODI and SaO 2 nadir, although not to the same extent as nasal CPAP . Tolerance is highly variable.…”

“…Nasal EPAP devices are effective in reducing the AHI, ODI and SaO 2 nadir, although not to the same extent as nasal CPAP. 27 Tolerance is highly variable.…”