Abstract
Although continuous positive airway pressure (CPAP) is the most effective therapy for obstructive sleep apnea (OSA), it is not always well tolerated by the patients. Previous physiological studies showed that pressure oscillations applied to the pharynx could activate upper airway muscles, but it is not clear whether these pressure oscillations could be tolerated during sleep in OSA patients. The aim of this study was to assess the tolerance of oscillating positive airway pressure (O-PAP) (a CPAP device delivering high-frequency pressure oscillations to the upper airway) compared to CPAP. Fourteen OSA patients currently on CPAP [age 59.9 ± 10.1 years old, BMI 34.8 ± 7.2 kg/m2, initial apnea–hypopnea index (AHI): 58.7 ± 25.2 events/h] used O-PAP or CPAP on two consecutive nights under polysomnography, in a single-blind randomized crossover design to assess sleep quality. A subtherapeutic pressure (70% of the optimal titrated pressure) was applied in both conditions and the residual AHI with each technique was also compared. There was no difference in measured or perceived sleep quality between the two treatment modalities (sleep efficiency 90.0% versus 88.1%, p = 0.54). Despite the small sample, we also found a trend toward a decrease in residual respiratory events with O-PAP compared to CPAP (median AHI 14.3 versus 20.5/h, p = 0.194). The good tolerance of O-PAP and the positive trend toward a reduction in residual AHI should stimulate further research on the effects of O-PAP in OSA patients.
Highlights
Obstructive sleep apnea (OSA) syndrome is caused by repetitive closure of the pharynx during sleep
There was a trend toward a decrease in apnea–hypopnea index (AHI) and oxygen desaturation index (ODI) with oscillating positive airway pressure (O-PAP) compared to continuous positive airway pressure (CPAP) alone, especially in NREM sleep and in the supine position, but none of these differences reached statistical significance
The main finding of this study is that O-PAP is well tolerated and does not alter objective nor subjective sleep quality in obstructive sleep apnea (OSA) patients
Summary
Obstructive sleep apnea (OSA) syndrome is caused by repetitive closure of the pharynx during sleep. Continuous positive airway pressure (CPAP) has been accepted as the standard treatment for moderate to severe OSA [1], many patients report discomfort or cannot tolerate it. Any means allowing a reduction of the pressure level without jeopardizing the primary CPAP function might improve patients’ comfort and, possibly, treatment adherence. The collapse of the upper airway in OSA is mainly due to a failure of the pharyngeal dilator muscles to counteract the negative intraluminal pressure generated by the inspiratory muscles. The pharynx is kept opened by tonic and phasic activations of the dilator muscles during the breathing cycle. These muscles are activated by a reflex
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