Effect of switching from continuous to bilevel positive airway pressure on sleep quality in patients with obstructive sleep apnea: the prospective POP IN VAuto study

Abstract

Background: Issues with tolerability and side effects can decrease continuous positive airway pressure (CPAP) device usage and the benefits of therapy. Different positive airway pressure (PAP) therapy modes providing expiratory pressure relief or using a different pressure during inspiration vs. expiration (bilevel PAP) may alleviate some of these issues. This multicenter, prospective study evaluated the effects of switching from CPAP to bilevel PAP (VAuto mode) on respiratory parameters, device usage, side effects and patient-reported outcomes in patients with obstructive sleep apnea (OSA).

Methods: Eligible OSA patients had started CPAP ≥3 months previously, had good compliance (mean 6.1±2.0 h/night) and well-controlled OSA [residual apnea-hypopnea index (AHI) 4.9±3.1/h] but had pressure tolerance issues or persistent side effects/discomfort. All were switched from CPAP to bilevel PAP (AirCurve 10 VAuto; ResMed). Effectiveness (residual AHI), sleep quality, daytime sleepiness, fatigue, therapy-related side effects, and patient satisfaction/preference were assessed after 3 months and 1 year.

Results: Forty patients were analyzed (68% male, age 64±11 years, body mass index 30.7±5.8 kg/m²). At 3 months and 1 year after switching to bilevel PAP, median [interquartile range] residual AHI was 4/h [2-5.3] and 3.7/h [1.8-5], respectively, and device usage was 7.0 [4.9-7.5] and 6.4 [4.4-7.3] h/night, respectively. Device switch was associated with significant reductions from baseline in expiratory PAP {from 12 [11-13] to 8 [7-9] cmH₂O at 3 months (P<0.001) and 9 [8-12] cmH₂O at 1 year (P=0.005)}, 95^th percentile pressure {from 14 [12-14] to 10 [9-11] and 10 [8-11] cmH2O; P<0.001 and P=0.001, respectively} and leak {from 1 [0-6] to 0 [0-1] and 0 [0-2] L/min; P=0.049 and P=0.033, respectively}. The Pittsburgh Sleep Quality Index score decreased significantly from baseline to 3 and 6 months [7.2±4.0 to 5.0±3.2 (P=0.005) and 4.5±2.7 (P<0.001), respectively]. CPAP-related mouth dryness, choking sensation and aerophagia were significantly improved one year after switching to bilevel PAP. Bilevel PAP was preferred over CPAP by 90% of patients.

Conclusions: Switching to bilevel PAP had several benefits in patients struggling with CPAP, facilitating therapy acceptance and ongoing device usage.

Keywords: Positive airway pressure (PAP); daytime sleepiness; obstructive sleep apnea (OSA); patient preference; patient reported outcomes; sleep quality.

Figure 1

Bilevel PAP profile and settings. EPAP, expiratory positive airway pressure; IPAP, inspiratory positive airway pressure; PAP, positive airway pressure.

Figure 2

Study flow chart. CPAP, continuous positive airway pressure; MAD, mandibular advancement device.

Figure 3

Changes in expiratory positive airway pressure (A) and leak (B) after switching from CPAP/APAP to bilevel PAP. APAP, automatic positive airway pressure; CPAP, continuous positive airway pressure; PAP, positive airway pressure.

Figure 4

Changes in side effect frequency after switching from CPAP/APAP to bilevel PAP. *, P<0.05 vs. CPAP/APAP. APAP, automatic positive airway pressure; CPAP, continuous positive airway pressure; FU, follow-up; PAP, positive airway pressure.