Treating Chronic Hypoventilation With Automatic Adjustable Versus Fixed EPAP Intelligent Volume-Assured Positive Airway Pressure Support (iVAPS): A Randomized Controlled Trial

Nigel McArdle; Clare Rea; Stuart King; Kathleen Maddison; Dinesh Ramanan; Sahisha Ketheeswaran; Lisa Erikli; Vanessa Baker; Jeff Armitstead; Glenn Richards; Bhajan Singh; David Hillman; Peter Eastwood

doi:10.1093/sleep/zsx136

Treating Chronic Hypoventilation With Automatic Adjustable Versus Fixed EPAP Intelligent Volume-Assured Positive Airway Pressure Support (iVAPS): A Randomized Controlled Trial

Sleep. 2017 Oct 1;40(10). doi: 10.1093/sleep/zsx136.

Authors

Nigel McArdle^{1

2}, Clare Rea², Stuart King^{1

2}, Kathleen Maddison^{1

2}, Dinesh Ramanan³, Sahisha Ketheeswaran³, Lisa Erikli³, Vanessa Baker^{1

2}, Jeff Armitstead³, Glenn Richards³, Bhajan Singh^{1

2}, David Hillman^{1

2}, Peter Eastwood^{1

2}

Affiliations

¹ Centre for Sleep Science, School of Anatomy, Physiology and Human Biology, University of Western Australia, Nedlands, Australia.
² West Australian Sleep Disorders Research Institute, Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Nedlands, Australia.
³ ResMed Science Centre, Bella Vista, Sydney, Australia.

PMID: 28958052
DOI: 10.1093/sleep/zsx136

Abstract

Objectives: New noninvasive ventilation (NIV) modes can automatically adjust pressure support settings to deliver effective ventilation in response to varying ventilation demands. It is recommended that fixed expiratory positive airway pressure (FixedEPAP) is determined by attended laboratory polysomnographic (PSG) titration. This study investigated whether automatically determined EPAP (AutoEPAP) was noninferior to FixedEPAP for the control of obstructive sleep apnea (OSA) during intelligent volume-assured pressure support (iVAPS) treatment of chronic hypoventilation.

Methods: In this randomized, double-blind, crossover study, patients with chronic hypoventilation and OSA used iVAPS with AutoEPAP or FixedEPAP over two separate nights of attended PSG. PSG recordings were scored by an independent scorer using American Academy of Sleep Medicine 2012 criteria.

Results: Twenty-five adults (14 male) with chronic hypoventilation secondary to obesity hypoventilation syndrome (n = 11), chronic obstructive pulmonary disease (n = 9), or neuromuscular disease (n = 5), all of whom were on established home NIV therapy, were included (age 57 ± 7 years, NIV for ≥3 months, apnea-hypopnea index [AHI] >5/hour). AutoEPAP was noninferior to FixedEPAP for the primary outcome measure (median [interquartile range] AHI 2.70 [1.70-6.05]/hour vs. 2.40 [0.25-5.95]/hour; p = .86). There were no significant between-mode differences in PSG sleep breathing and sleep quality, or self-reported sleep quality, device comfort, and patient preference. Mean EPAP with the Auto and Fixed modes was 10.8 ± 2.0 and 11.8 ± 3.9 cmH2O, respectively (p = .15).

Conclusions: In patients with chronic hypoventilation using iVAPS, the AutoEPAP algorithm was noninferior to FixedEPAP over a single night's therapy.

Keywords: hypoventilation; intermittent positive pressure ventilation; noninvasive ventilation; sleep apnea syndromes; volume-assured pressure support.

Publication types

Randomized Controlled Trial

MeSH terms

Adult
Cross-Over Studies
Double-Blind Method
Female
Humans
Lung / physiology
Male
Middle Aged
Neuromuscular Diseases / complications
Obesity Hypoventilation Syndrome / complications
Obesity Hypoventilation Syndrome / therapy*
Polysomnography / methods*
Positive-Pressure Respiration / instrumentation*
Positive-Pressure Respiration / methods*
Pulmonary Disease, Chronic Obstructive / complications
Respiration
Sleep / physiology*
Tidal Volume / physiology