Obstructive sleep apnoea: bilevel effective as second-line therapy in patients failing CPAP

  • Ishak A & al.
  • Respirology
  • 12 Aug 2019

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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Takeaway

  • In patients with moderate-severe obstructive sleep apnoea (OSA) who failed continuous positive airway pressure (CPAP) therapy, the use of bilevel positive airway pressure (BPAP) therapy significantly improved adherence and symptom control compared with CPAP.

Why this matters

  • Findings suggest that BPAP can be successfully employed in obese patients with moderate-severe OSA who fail CPAP therapy because of low adherence.
  • However, treatment-associated costs do not justify the use of BPAP as a first-line therapy despite the efficacy, and its use should be limited to specialist centres to identify eligible patients.

Study design

  • This prospective observational study included 52 patients with OSA (71% male), who failed CPAP (usage
  • CPAP used for 199 (range, 106-477) days before referral for BPAP.
  • Primary outcome: nightly adherence to treatment (BPAP vs CPAP).
  • Funding: None disclosed.

Key results

  • Reasons reported for sub-optimal CPAP adherence included high pressures (23%), uncontrolled symptoms (23%), mask problems (21%), adverse effects (13%), claustrophobia (8%), co-morbidities (8%) and other issues (4%).
  • BPAP vs CPAP therapy was associated with:
    • lower expiratory positive airway pressures (10 [8-12] vs 16.8 [15.7-19.2] cm H2O; P=.001);
    • better adherence (7.0 [4.0-8.5] vs 2.5 [1.6-6.7] hours/night; P=.028); and
    • better symptom control (Epworth Sleepiness Scale, 4.0 [1.0-7.0] vs 10.0 [6.0-17.0] points; P=.039).
  • Higher number of patients using BPAP achieved adequate nightly adherence (adherence >4 hours/night) vs those using CPAP therapy (75.7% vs 42.9%; P=.045).

Limitation

  • Observational design.