PAP Adherence and Nasal Resistance: A Randomized Control Trial of CPAPflex vs CPAP in World Trade Center Responders

Details

• Personal Author:
  Ayappa, Indu ; Black, Kathleen ; Carson, Jeffrey L. ; Chitkara, Nishay ; de la Hoz, Rafael E. ; Harrison, Denise ; Lu, Shou-En ; Rapoport, David M. ; Sanders, Haley ; Sunderram, Jag ; Twumasi, Akosua ; Udasin, Iris ; Wang, Han
• Description:
  Rationale: Continuous positive airway pressure (CPAP) adherence is often poor in obstructive sleep apnea (OSA) and may be influenced by nasal resistance. CPAP with a reduction of expiratory pressure (CPAPflex) may reduce discomfort in those with high nasal resistance and improve adherence in this subgroup. Objectives: To evaluate the association of positive airway pressure (PAP) treatment adherence to nasal resistance and examine if CPAPflex improves adherence over CPAP in subjects with high nasal resistance. Methods: A randomized double-blind crossover trial of 4 weeks each of CPAPflex versus CPAP in subjects exposed to World Trade Center dust with OSA stratified by nasal resistance, measured by 4-Phase Rhinomanometry. Results: Three hundred seventeen subjects with OSA (mean, apnea-hypopnea index with 4% O2 desaturation for hypopnea = 17 +/- 14/h) were randomized. Overall, PAP adherence was poor, but adherence to CPAP (n = 239; mean hours per night [95% confidence interval (CI)]), 1.97 h (1.68 to 2.26) was greater than adherence to CPAPflex (n = 249; 1.65 h [1.39 to 1.91]; difference of 0.31 h [0.03; 0.6]; P < 0.05). Contrary to our hypothesis there was no correlation between nasal resistance and adherence to CPAP (r = 0.098; P = not significant) or CPAPflex (r = 0.056; P = not significant). There was no difference in adherence between CPAP and CPAPflex (mean delta hours [95% CI]) in subjects with low resistance (0.33 h [-0.10 to 0.76]) or high nasal resistance (0.26 h [-0.14 to 0.66]). No significant differences were observed in any of the secondary outcomes between PAP modes. Conclusions: Contrary to expectations, our data do not show better adherence to CPAPflex than to CPAP in subjects with high or low nasal resistance and do show clinically insignificant better adherence overall with CPAP. [Description provided by NIOSH]
• Subjects:
  Dust Nose Occupational Health Respiratory System Safety Sense Organs September 11 Terrorist Attacks
• Keywords:
  Author Keywords: Sleep Apnea - Obstructive; Reduced Expiratory Pressure; Sleep Disordered Breathing; Therapy Sleep Apnea; Breathing; Airway Resistance; Airway Obstruction; Nasal Cavity; World Trade Center; WTC; Dust Exposure; Clinical Symptoms; Breathing Pressures;
• ISSN:
  2329-6933
• Document Type:
  Text
• Funding:
  Cooperative Agreement ; Contract
• Genre:
  Journal Article
• Place as Subject:
  New Jersey ; New York ; OSHA Region 2
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Pages in Document:
  43 pdf pages
• NIOSHTIC Number:
  nn:20061478
• Citation:
  Ann Am Thorac Soc 2021 Apr; 18(4):668-677
• Contact Point Address:
  Jag Sunderram, Division of Pulmonary and Critical Care Medicine, Department of Medicine, 1 Robert Wood Johnson Place, MEB 572, New Brunswick, NJ 08901
• Email:
  sunderja@rwjms.rutgers.edu
• Federal Fiscal Year:
  2021
• Performing Organization:
  RBHS-Robert Wood Johnson Medical School, Piscataway, New Jersey
• Peer Reviewed:
  True
• Start Date:
  20120901
• Source Full Name:
  Annals of the American Thoracic Society
• End Date:
  20170831
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:9a97c27147e276b02aba9fbb083154da43b7b19352ecf5945d86582cdaa54b53fff5cc19a5949db59c9f2b31ef8d2999fd576f29e47e498ead38ce4c8f3b75a7
• Download URL:
  https://stacks.cdc.gov/view/cdc/231601/cdc_231601_DS1.pdf
• File Type:
  [PDF - 486.64 KB ]