The impact of changing the pressure generating device in people with sleep apnoea using Continuous Positive Airway Pressure (CPAP) less than 4 hours per night
| ISRCTN | ISRCTN31885415 |
|---|---|
| DOI | https://doi.org/10.1186/ISRCTN31885415 |
| Secondary identifying numbers | N/A |
- Submission date
- 07/01/2010
- Registration date
- 18/03/2010
- Last edited
- 05/07/2016
- Recruitment status
- No longer recruiting
- Overall study status
- Completed
- Condition category
- Respiratory
Prospectively registered
Protocol
Statistical analysis plan
Results
Individual participant data
Plain English summary of protocol
Not provided at time of registration
Contact information
Dr Ian Smith
Scientific
Scientific
Respiratory support and sleep centre
Papworth Hospital NHS Trust
Papworth Everard
Papworth Everard
CB23 3RE
United Kingdom
Study information
| Study design | Single-centre two-period two-arm randomised controlled crossover group trial |
|---|---|
| Primary study design | Interventional |
| Secondary study design | Randomised cross over trial |
| Study setting(s) | Other |
| Study type | Treatment |
| Participant information sheet | Not available in web format, please use contact details below to request a patient information sheet |
| Scientific title | The impact of changing the pressure generating device in people with sleep apnoea using Continuous Positive Airway Pressure (CPAP) less than 4 hours per night: a randomised controlled crossover trial |
| Study objectives | Does changing to Bi−level positive airway pressure (Bi−level PAP) support increases usage in obstructive sleep apnoea (OSA) patients who have suboptimal compliance with fixed continuous positive airway pressure (CPAP) due to pressure intolerance? The most effective treatment for symptomatic, moderate to severe OSA is with CPAP. To derive optimal benefit it is recommended that CPAP should be used for at least 4 hours per night. However, only 46-83 % of individuals use it for more than 4 hours every night. Different mechanical interventions (Auto positive airway pressure, Bi-level Positive airway pressure, and expiratory release positive airway pressure) have failed to show any significant improvement in compliance. Most of these studies have studied unselected subjects first initiating therapy. It is possible that subjects who after all simple measures to improve compliance have been addressed are still non-compliant may show a demonstrable improvement with a change of mode of pressure delivery. In this study we will evaluate the role of Bi-level PAP in OSA patients who remain poorly compliant with CPAP (despite appropriate interventions to improve local side effects and/or who complain of pressure related problems). |
| Ethics approval(s) | Cambridgeshire 2 Research and Ethics Committee (REC), April 2009, ref: 09/H0308/68 |
| Health condition(s) or problem(s) studied | Obstructive sleep apnoea |
| Intervention | The study will have a two-period, two-treatment crossover randomised controlled trial design. Patients with average CPAP use less than 4 hours per night who meet the inclusion and none of the exclusion criteria will be randomised to either receive a Bi-level positive airway pressure (Bi-PAP) device first or to receive a brand of fixed CPAP machine different from the one they have used previous to entering the study. They will have a baseline measure of CPAP compliance, daytime sleepiness and quality of life. Both groups will receive a similar level of continuing clinical support by the CPAP practitioners and Respiratory Support and Sleep Centre (RSSC) nurses (24 hour telephone helpline, early clinic review and advice if there is any problem) as per the standard clinical care at our centre. They will then be reviewed at 4 weeks with repeat measurements of compliance, sleepiness and quality of life. For the second period, those that received CPAP in the first period will get Bi-level PAP and vice versa. They will go home with the advice to start using the new device after 2 weeks. Until that time they will stay on their initial CPAP. This will give them a washout period of two weeks. They will then be followed up for the study at 10 weeks with repeat measures of CPAP compliance, daytime sleepiness and quality of life indices to look for any measurable changes. Patients will be selected from a cohort of CPAP users who are followed up at Papworth hospital. |
| Intervention type | Device |
| Pharmaceutical study type(s) | |
| Phase | Not Applicable |
| Drug / device / biological / vaccine name(s) | |
| Primary outcome measure | CPAP compliance (measured as average CPAP use in hours per night) |
| Secondary outcome measures | 1. Improvement in generic quality of life index - Short form 36 (SF-36) 2. Improvement in sleep apnoea quality of life index (SAQLI) 3. Epworth sleepiness scale score (ESS) 4. Side effects 5. Comfort level 6. Patient preference for different device 7. Changes in objective measure of excessive daytime sleepiness (OSLER test) |
| Overall study start date | 01/04/2009 |
| Completion date | 30/04/2010 |
Eligibility
| Participant type(s) | Patient |
|---|---|
| Age group | Adult |
| Sex | Both |
| Target number of participants | 40 |
| Key inclusion criteria | 1. Diagnosed OSA (AHI greater than 4 per hour) 2. On CPAP for at least 6 weeks with average use less than 4 hours per night 3. Intolerant of CPAP despite ensuring pressure minimised to least effective, mask fit and humidification reviewed as appropriate |
| Key exclusion criteria | 1. Refuse informed consent or unable to give consent. 2. AHI less than 5 per hour off CPAP. 3. Moderate to severe airflow obstruction (Forced Expiratory Volume in 1 second [FEV1] / Forced Vital Capacity Percentage [FVC%] less than 60%). 4. Central sleep apnoea (central events more than 50% of all the apnoeas / hypopnoeas). 5. Decompensated congestive heart failure on clinical examination. 6. Hypercapnia (PaCO2 >6.5 KPa). 7. Previous exposure to Bi−level positive airway pressure support. |
| Date of first enrolment | 01/04/2009 |
| Date of final enrolment | 30/04/2010 |
Locations
Countries of recruitment
- England
- United Kingdom
Study participating centre
Papworth Hospital NHS Trust
Papworth Everard
CB23 3RE
United Kingdom
CB23 3RE
United Kingdom
Sponsor information
Papworth Hospital NHS Foundation Trust (UK)
Hospital/treatment centre
Hospital/treatment centre
Dr Alistair Grant
Senior R and D manager
Papworth hospital NHS foundation trust
Papworth Everard
CB23 3RE
England
United Kingdom
"ROR" |
https://ror.org/01qbebb31 |
|---|
Funders
Funder type
Hospital/treatment centre
Papworth Hospital NHS Foundation Trust (UK) - (Local R& D ref: PO1349)
No information available
B and D electromedicals (UK) - limited funding
No information available
Results and Publications
| Intention to publish date | |
|---|---|
| Individual participant data (IPD) Intention to share | No |
| IPD sharing plan summary | Not provided at time of registration |
| Publication and dissemination plan | Not provided at time of registration |
| IPD sharing plan |
Study outputs
| Output type | Details | Date created | Date added | Peer reviewed? | Patient-facing? |
|---|---|---|---|---|---|
| Results article | results | 01/06/2015 | Yes | No |
Editorial Notes
05/07/2016: Publication reference added.
