Track topics on Twitter Track topics that are important to you
The purpose of the project is:
1. to determine the incidence of complex sleep apnea
2. to determine what percentage of cases will resolve over time with therapy with Continuous Positive Airway Pressure
3. Determine whether there is any difference in outcome, in those with persistent complex sleep apnea on CPAP, between those treated with CPAP or adaptive servo-ventilation.
Patients with suspected obstructive sleep apnea (OSA) are studied overnight in a sleep laboratory, as part of their routine clinical management. If they are found to have OSA during the first half of the night, they are started on continuous positive airway pressure (CPAP) by nasal mask as part of their routine clinical management. A certain percentage of these patients (best estimate from the literature 15%) will develop central sleep apnea (CSA) during their treatment with CPAP.
Participants will be recruited from patients treated with Continuous Positive Airway Pressure (CPAP) for obstructive sleep apnea who develop central sleep apnea (CSA) on CPAP, and are willing to give informed consent .
Patients will be treated with the "best CPAP" pressure, as determined by the sleep physician reading their sleep study. This is defined as the minimum pressure associated with elimination of obstructive events. Patients will be treated with CPAP for 12 weeks. Following treatment, patients will be brought back for a second sleep study to be assessed on CPAP.
Those that demonstrate resolution of CSA on the sleep study will continue on CPAP for an additional 12 weeks. Those that demonstrate persistent CSA will be randomized to either "best CPAP" or Adaptive Servo-ventilation (ASV) therapy for an additional 12 weeks. ASV will be titrated during the second sleep study to determine optimal settings. Patients will be compared at the end of 12 and 24 weeks of treatment regarding response to therapy. This will be assessed by compliance with therapy (as monitored by a smart card within the positive pressure machine), improvement in sleepiness as measured by the Epworth Sleepiness Score, and change in quality of life as measured by the Sleep Apnea Quality of Life Index (SAQLI) a validated quality of life instrument specific to sleep apnea.
In addition, in those who demonstrated persistent central apneas after 12 weeks of CPAP therapy, and were randomized to CPAP or ASV, a third and final sleep study will be done to assess the residual apnea-hypopnea index (the number of respiratory events divided by the number of hours of sleep) on therapy. In those randomized to CPAP who have a persistent poor clinical response associated with an abnormal residual AHI after 24 weeks of treatment, a further 12 week trial of ASV will be undertaken to assess whether it offers any benefit.
In addition to assessing the effect of treatment, the original diagnostic polysomnogram of all patients with complex sleep apnea will be analyzed to determine if there are any polysomnographic features that could be utilized to predict complex sleep apnea before CPAP is applied, (for example: 1) evidence of mixed apneas; or 2) a component of central apneas in addition to the predominant pattern of OSA.)
Allocation: Randomized, Control: Active Control, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Parallel Assignment, Masking: Single Blind, Primary Purpose: Treatment
Non-invasive positive pressure ventilator
Miseracordia Sleep Disorders Centre
Not yet recruiting
University of Manitoba
Published on BioPortfolio: 2014-07-23T21:08:53-0400
This study is testing the hypothesis of whether continuous positive airway pressure (CPAP) therapy improves placental histopathology and secretory function. The main aims of the study are ...
Primary aim of the TURKAPNE (The Turkish Sleep Apnea Database) study is to generate a cross-sectional nationwide database to define clinical and polysomnographic characteristics of the sle...
Obstructive sleep apnea (OSA) is a prevalent disorders characterized by intermittent obstructions of the upper airway during sleep. Continuous Positive Airway Pressure (CPAP) has been show...
Obstructive sleep apnea is a problem for a large number of children and can result in problems with thinking patterns, behaviors and sleep if left untreated. Little is known about how posi...
This is a research study of asthma and sleep apnea. Our hypothesis is that untreated sleep apnea causes inflammation in the lung, which can worsen asthma. We believe treatment of sleep a...
This study aimed to determine the effect of combining positive airway pressure (PAP) therapy and mandibular advancement device (MAD) in patients with severe obstructive sleep apnea (OSA) who were pres...
Continuous positive airway pressure (CPAP) therapy is an efficacious treatment for patients diagnosed with obstructive sleep apnea (OSA). However, there are only few data on long-term adherence. The a...
Treatment-emergent central sleep apnea (TE-CSA) is defined as the emergence or persistence of central respiratory events during the initiation of positive airway pressure (PAP) without a back-up rate ...
Debate persists as to whether obstructive sleep apnea (OSA) is an independent risk factor for atherosclerosis. The purpose of this study was to compare carotid intima-media thickness (IMT), an early s...
To clarify whether unmasking of central sleep apnea during continuous positive airway pressure (CPAP) initiation can be identified from initial diagnostic polysomnography (PSG) in patients with heart ...
A condition associated with multiple episodes of sleep apnea which are distinguished from obstructive sleep apnea (SLEEP APNEA, OBSTRUCTIVE) by the complete cessation of efforts to breathe. This disorder is associated with dysfunction of central nervous system centers that regulate respiration. This condition may be idiopathic (primary) or associated with lower brain stem lesions; chronic obstructive pulmonary disease (LUNG DISEASES, OBSTRUCTIVE); HEART FAILURE, CONGESTIVE; medication effect; and other conditions. Sleep maintenance is impaired, resulting in daytime hypersomnolence. Primary central sleep apnea is frequently associated with obstructive sleep apnea. When both forms are present the condition is referred to as mixed sleep apnea (see SLEEP APNEA SYNDROMES). (Adams et al., Principles of Neurology, 6th ed, p395; Neurol Clin 1996;14(3):611-28)
Disorders characterized by multiple cessations of respirations during sleep that induce partial arousals and interfere with the maintenance of sleep. Sleep apnea syndromes are divided into central (see SLEEP APNEA, CENTRAL), obstructive (see SLEEP APNEA, OBSTRUCTIVE), and mixed central-obstructive types.
Application of positive pressure to the inspiratory phase when the patient has an artificial airway in place and is connected to a ventilator.
Dyssomnias (i.e., insomnias or hypersomnias) associated with dysfunction of internal sleep mechanisms or secondary to a sleep-related medical disorder (e.g., sleep apnea, post-traumatic sleep disorders, etc.). (From Thorpy, Sleep Disorders Medicine, 1994, p187)
Techniques for effecting the transition of the respiratory-failure patient from mechanical ventilation to spontaneous ventilation, while meeting the criteria that tidal volume be above a given threshold (greater than 5 ml/kg), respiratory frequency be below a given count (less than 30 breaths/min), and oxygen partial pressure be above a given threshold (PaO2 greater than 50mm Hg). Weaning studies focus on finding methods to monitor and predict the outcome of mechanical ventilator weaning as well as finding ventilatory support techniques which will facilitate successful weaning. Present methods include intermittent mandatory ventilation, intermittent positive pressure ventilation, and mandatory minute volume ventilation.
Sleep disorders disrupt sleep during the night, or cause sleepiness during the day, caused by physiological or psychological factors. The common ones include snoring and sleep apnea, insomnia, parasomnias, sleep paralysis, restless legs syndrome, circa...
Asthma COPD Cystic Fibrosis Pneumonia Pulmonary Medicine Respiratory Respiratory tract infections (RTIs) are any infection of the sinuses, throat, airways or lungs. They're usually caused by viruses, but they can also ...