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Randomized Controlled Trial
. 2024 Dec:124:268-275.
doi: 10.1016/j.sleep.2024.09.028. Epub 2024 Sep 18.

Kairos positive airway pressure (KPAP) equals continuous PAP in effectiveness, and offers superior comfort for obstructive sleep apnea treatment

David P White  1 , Ludovico Messineo  2 , Evelyn Thompson  3 , Bryan Hughes  3 , Wilson D Lannom  3 , Bernard Hete  3 , Abinash Joshi  3 , William H Noah  3
Affiliations
Free article
Randomized Controlled Trial

Kairos positive airway pressure (KPAP) equals continuous PAP in effectiveness, and offers superior comfort for obstructive sleep apnea treatment

David P White et al. Sleep Med. 2024 Dec.
Free article

Erratum in

Abstract

Study objectives: A recent study challenged the prevailing clinical view that maintaining inspiratory positive airway pressure (IPAP) is necessary for upper airway patency, demonstrating no differences in apnea hypopnea index (AHI) between continuous PAP (CPAP) with and without a resistor to reduce IPAP. In this study, we assessed the effect of Kairos PAP (KPAP), a new algorithm which features multiple drops in IPAP, only returning to therapeutic pressure near the end expiration, on sleep apnea severity and subjective comfort.

Methods: Two randomized clinical trials were conducted. In the Efficacy trial, the effect of KPAP vs. CPAP on AHI in PAP-treated OSA patients was examined using a split-night design, adjusting for period, sequence and fraction of supine sleep (mixed models). Unintentional leak differences between treatments were also examined. Exploratory analyses assessed the effect of KPAP vs. CPAP on key polysomnography outcomes. In the Comfort trial, we tested subjective preference for KPAP vs. CPAP at 9 and 13 cmH2O in PAP-naïve OSA patients.

Results: In the Efficacy trial (N = 48), KPAP reduced AHI more than CPAP (mean difference [95%CI]: -0.5 [-0.8, -0.2] events/h, P = 0.007). Unintentional leak was also reduced by over 50 % (-2.5 [-3.2, -1.7] L/min, P < 0.001). No significant change was observed in the exploratory variables assessed. In the Comfort trial (N = 150), 69 [61, 77] % and 84 [77, 89] % of participants preferred KPAP over CPAP at 9 and 13 cmH2O, respectively (P < 0.001).

Conclusions: KPAP is as effective as CPAP in reducing respiratory events, but is more comfortable and potentially better tolerated.

Keywords: Alternative OSA treatments; Inspiratory pressure; Kairos PAP; Pressure at the right time.

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Conflict of interest statement

Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: David P White reports a relationship with SleepRes that includes: consulting or advisory. William Noah reports a relationship with SleepRes that includes: board membership. William Noah has patent pending to William Noah. LM received industry grants from Apnimed, Inc and Prosomnus unrelated to this work. DPW received consultancy fees for Bairitone, Cerebra Health, Cryosa, Mosanna, Onera, Philips Respironics, Resonea, Xtrodes, and Apnimed unrelated to this work. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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