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BPAP a potential alternative for OSA patients failing regular CPAP

04 Apr 2020

Bilevel positive airway pressure (BPAP) appears to be an effective therapeutic option in patients with moderate-to-severe obstructive sleep apnoea (OSA) who fail continuous positive airway pressure (CPAP) therapy due to low adherence, achieving adequate control of sleep-disordered breathing and its symptoms while being well tolerated, suggests a study.

Fifty-two patients with OSA requiring CPAP >15 cm H2O (mean age, 58 years; 71 percent male; body mass index [BMI], 42.6 (10.1) kg/m2; apnoea–hypopnea index (AHI), 51.1/h) met the eligibility criteria. Of these, 62 percent had respiratory comorbidities affecting nocturnal breathing, including obesity hypoventilation syndrome and chronic obstructive pulmonary disease; 25 percent had neuromuscular conditions; and 17 percent had cardiovascular disease.

Patients used CPAP for 199 days (range, 106–477) prior to referral for BPAP. CPAP failure were due to the following: intolerant pressures (23 percent), uncontrolled symptoms (23 percent), mask problems (21 percent), adverse effects (13 percent), claustrophobia (8 percent), comorbidities (8 percent) and other issues (4 percent).

Lower expiratory positive airway pressures were required with BPAP compared to CPAP (10.0 vs 16.8 cm H2O; p=0.001). Patients showed better adherence to BPAP (7.0 vs 2.5 h/night; p=0.028) and achieved better control of symptoms (Epworth Sleepiness Scale [ESS], 4.0 vs 10.0 points; p=0.039).

This study included OSA patients who failed CPAP (usage <4 h/day) and were referred to a tertiary sleep centre between 2014 and 2017 for BPAP. The authors recorded the following data: age, gender, BMI, comorbidities, CPAP use and reasons for failure, ESS, sleep study data, spirometry data and average maximum nightly compliance.

“CPAP is the most common treatment for OSA, but many patients fail long-term therapy,” the authors said. “BPAP is a potential alternative.”

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Most Read Articles
01 Dec 2020
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Dr. Hsu Li Yang, Dr. Tan Thuan Tong, Dr. Andrea Kwa, 08 Jan 2021
Antimicrobial resistance has become increasingly dire as the rapid emergence of drug resistance, especially gram-negative pathogens, has outpaced the development of new antibiotics. At a recent virtual symposium, Dr Hsu Li Yang, Vice Dean (Global Health) and Programme Leader (Infectious Diseases), NUS Saw Swee Hock School of Public Health, presented epidemiological data on multidrug-resistant (MDR) gram-negative bacteria (GNB) in Asia, while Dr Tan Thuan Tong, Head and Senior Consultant, Department of Infectious Diseases, Singapore General Hospital (SGH), focused on the role of ceftazidime-avibactam in MDR GNB infections. Dr Andrea Kwa, Assistant Director of Research, Department of Pharmacy, SGH, joined the panel in an interactive fireside chat, to discuss challenges, practical considerations, and solutions in MDR gram-negative infections. This Pfizer-sponsored symposium was chaired by Dr Ng Shin Yi, Head and Senior Consultant of Surgical Intensive Care, SGH.
Jairia Dela Cruz, 3 days ago
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