- ICH GCP
- US Clinical Trials Registry
- Klinisk utprøving NCT02209220
Impact of Automatic Positive Airway Pressure on Treatment Compliance in OSA Patients Awaiting Bariatric Surgery (APAP-CPAP)
1. august 2019 oppdatert av: Frédéric Sériès, Laval University
Impact of Automatic Positive Airway Pressure on Treatment Compliance in Obstructive Sleep Apnea Patients Awaiting Bariatric Surgery
Obstructive sleep apnea (OSA) is a syndrome characterized by intermittent dynamic obstruction of the upper airways that causes a fall in oxygen saturation, reflex sympathetic activation and sleep micro-arousals.
In surgical patients, OSA is a well-known risk factor for perioperative complications.
At Institut Universitaire de cardiologie et de Pneumologie de Quebec (IUCPQ), the investigators perform more than 450 bariatric surgeries per year.
Consequently, the identification and management of OSA in this high-risk surgical population is an essential part of practice.
Actual guidelines recommend that treatment for OSA be initiated before the surgical procedure.
Presently, the first line treatment for OSA is continuous positive airway pressure (CPAP) therapy delivering a fixed pressure continuously to maintain the patency of the upper airways.
However the compliance to this therapy is poor.
An available alternative is automatic positive airway pressure (APAP) which delivers a variable amount of pressure to prevent reduction in airflow that accompanies upper airway obstruction.
The APAP delivers the lowest pressure needed to prevent upper airways collapse.
APAP significantly reduces the mean level of pressure delivered in comparison to conventional treatment.
Theoretically, it seems logical that applying the lowest pressure necessary would allow a better device-patient synchrony and therefore improve patient's comfort.Recent trials comparing APAP and CPAP have shown that APAP is non-inferior to CPAP in controlling obstructive events.
APAP would be a valuable alternative if it was not for its excess cost.
However, APAP improves compliance to treatment in two types of population: poor compliant subjects and those needing high pressure levels.
The investigators know that compliance to positive pressure is poor in patients without excessive daytime sleepiness, which represents the majority of patient waiting bariatric surgery.
Moreover, in patients needing levels of pressure ≥ 10 water cm (cmH20), APAP improves treatment compliance, minimises side effects and improves quality of life.
The review of 180 files of OSA patients treated by CPAP who had bariatric surgery in our center in 2012 demonstrated that the majority of patients needed high level pressure.
These values suggest that APAP could improve treatment compliance in apneic patients waiting for bariatric surgery because they are usually poorly symptomatic and they generally require high positive pressure level.
Studieoversikt
Status
Fullført
Intervensjon / Behandling
Studietype
Intervensjonell
Registrering (Forventet)
50
Fase
- Ikke aktuelt
Kontakter og plasseringer
Denne delen inneholder kontaktinformasjon for de som utfører studien, og informasjon om hvor denne studien blir utført.
Studiesteder
-
-
Quebec
-
Quebec City, Quebec, Canada, G1V 4G5
- Institut Universitaire De Cardiologie Et De Pneumologie De Québec
-
-
Deltakelseskriterier
Forskere ser etter personer som passer til en bestemt beskrivelse, kalt kvalifikasjonskriterier. Noen eksempler på disse kriteriene er en persons generelle helsetilstand eller tidligere behandlinger.
Kvalifikasjonskriterier
Alder som er kvalifisert for studier
18 år og eldre (Voksen, Eldre voksen)
Tar imot friske frivillige
Nei
Kjønn som er kvalifisert for studier
Alle
Beskrivelse
Inclusion Criteria:
- Obese patients with a BMI ≥ 40 kg/m2 or ≥ 35 kg/m2 with additional risk factors for cardiovascular disease and eligible for bariatric surgery;
- Laparoscopic bariatric surgery planned in 2-6 months. Procedures include biliopancreatic diversion with duodenal switch and sleeve gastrectomy;
- Recent diagnosis of obstructive sleep apnea made by a sleep study. The sleep study must be a overnight pulse oximetry showing a 3% desaturation index ≥ 25/hour or a polysomnography with a apnea + hypopnea index (AHI) ≥ 25/hour* ;
- No previous use of positive airway pressure device;
- ≥18 year old.
Exclusion Criteria:
- Severe comorbidities (respiratory, cardiac, neurologic or metabolic unstable disease);
- Central sleep apnea;
- Obesity hypoventilation syndrome;
- Planned bariatric surgery by laparotomy;
- Contraindications to positive airway pressure therapy: pneumothorax within the preceding 6 months, cerebrospinal fluid leak, cranial surgery or trauma within the last year.
Studieplan
Denne delen gir detaljer om studieplanen, inkludert hvordan studien er utformet og hva studien måler.
Hvordan er studiet utformet?
Designdetaljer
- Primært formål: Behandling
- Tildeling: Randomisert
- Intervensjonsmodell: Parallell tildeling
- Masking: Ingen (Open Label)
Våpen og intervensjoner
Deltakergruppe / Arm |
Intervensjon / Behandling |
---|---|
Aktiv komparator: Automatic positive airway pressure
Automatic positive airway pressure treatment of obstructive sleep apnea
|
Andre navn:
|
Aktiv komparator: Continuous positive airway pressure
Continuous positive airway pressure for the treatment of obstructive sleep apnea
|
Andre navn:
|
Hva måler studien?
Primære resultatmål
Resultatmål |
Tiltaksbeskrivelse |
Tidsramme |
---|---|---|
Compliance of APAP and CPAP
Tidsramme: at time of surgery
|
Total utilisation time, daily hours of utilisation, percentage of nights with positive pressure
|
at time of surgery
|
Sekundære resultatmål
Resultatmål |
Tiltaksbeskrivelse |
Tidsramme |
---|---|---|
Mean pressure level with APAP and CPAP
Tidsramme: at time of surgery
|
Pressure applied (mean pressure and 90th/95th percentile), apnea hypopnea index, amount of mask leaks.
|
at time of surgery
|
Mean pressure level with APAP and CPAP
Tidsramme: 1 month
|
Pressure applied (mean pressure and 90th/95th percentile), apnea hypopnea index, amount of mask leaks.
|
1 month
|
Residual apnea + hypopnea index
Tidsramme: at time of surgery
|
Number of residual respiratory events recorded by the positive pressure device during the treatment period
|
at time of surgery
|
Residual apnea + hypopnea index
Tidsramme: 1 month
|
Number of residual respiratory events recorded by the positive pressure device during the treatment period
|
1 month
|
epworth sleepiness score
Tidsramme: at time of surgery
|
Somnolence measured by Epworth Sleepiness Scale;
|
at time of surgery
|
quality of life score with APAP and CPAP
Tidsramme: at time of surgery
|
Quality of life measured by Questionnaire sur la Qualité de vie du Québec
|
at time of surgery
|
Positive pressure therapy adverse events
Tidsramme: at time of surgery
|
Positive airway pressure adverse effects measured by a visual analogic scale.
|
at time of surgery
|
Compliance of APAP and CPAP
Tidsramme: 1 month
|
Total utilisation time, daily hours of utilisation, percentage of nights with positive pressure
|
1 month
|
Samarbeidspartnere og etterforskere
Det er her du vil finne personer og organisasjoner som er involvert i denne studien.
Sponsor
Samarbeidspartnere
Etterforskere
- Hovedetterforsker: Frédéric Séries, MD, Laval University
Publikasjoner og nyttige lenker
Den som er ansvarlig for å legge inn informasjon om studien leverer frivillig disse publikasjonene. Disse kan handle om alt relatert til studiet.
Generelle publikasjoner
- Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep. 1991 Dec;14(6):540-5. doi: 10.1093/sleep/14.6.540.
- Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med. 1993 Apr 29;328(17):1230-5. doi: 10.1056/NEJM199304293281704.
- Kaw R, Chung F, Pasupuleti V, Mehta J, Gay PC, Hernandez AV. Meta-analysis of the association between obstructive sleep apnoea and postoperative outcome. Br J Anaesth. 2012 Dec;109(6):897-906. doi: 10.1093/bja/aes308. Epub 2012 Sep 6.
- Kuna ST, Reboussin DM, Borradaile KE, Sanders MH, Millman RP, Zammit G, Newman AB, Wadden TA, Jakicic JM, Wing RR, Pi-Sunyer FX, Foster GD; Sleep AHEAD Research Group of the Look AHEAD Research Group. Long-term effect of weight loss on obstructive sleep apnea severity in obese patients with type 2 diabetes. Sleep. 2013 May 1;36(5):641-649A. doi: 10.5665/sleep.2618.
- Smith I, Lasserson TJ. Pressure modification for improving usage of continuous positive airway pressure machines in adults with obstructive sleep apnoea. Cochrane Database Syst Rev. 2009 Oct 7;(4):CD003531. doi: 10.1002/14651858.CD003531.pub3.
- Parish JM, Miller BW, Hentz JG. Autotitration positive airway pressure therapy in patients with obstructive sleep apnea who are intolerant of fixed continuous positive airway pressure. Sleep Breath. 2008 Aug;12(3):235-41. doi: 10.1007/s11325-007-0158-2. Epub 2007 Nov 28.
- Wolkove N, Baltzan M, Kamel H, Dabrusin R, Palayew M. Long-term compliance with continuous positive airway pressure in patients with obstructive sleep apnea. Can Respir J. 2008 Oct;15(7):365-9. doi: 10.1155/2008/534372.
- Massie CA, McArdle N, Hart RW, Schmidt-Nowara WW, Lankford A, Hudgel DW, Gordon N, Douglas NJ. Comparison between automatic and fixed positive airway pressure therapy in the home. Am J Respir Crit Care Med. 2003 Jan 1;167(1):20-3. doi: 10.1164/rccm.200201-022OC. Epub 2002 Oct 4.
- Lacasse Y, Bureau MP, Series F. A new standardised and self-administered quality of life questionnaire specific to obstructive sleep apnoea. Thorax. 2004 Jun;59(6):494-9. doi: 10.1136/thx.2003.011205.
- Kermelly SB, Lajoie AC, Boucher ME, Series F. Impact of continuous positive airway pressure mode on adherence to treatment in obstructive sleep apnea patients awaiting bariatric surgery. J Sleep Res. 2021 Oct;30(5):e13288. doi: 10.1111/jsr.13288. Epub 2021 Feb 6.
Studierekorddatoer
Disse datoene sporer fremdriften for innsending av studieposter og sammendragsresultater til ClinicalTrials.gov. Studieposter og rapporterte resultater gjennomgås av National Library of Medicine (NLM) for å sikre at de oppfyller spesifikke kvalitetskontrollstandarder før de legges ut på det offentlige nettstedet.
Studer hoveddatoer
Studiestart
1. september 2014
Primær fullføring (Faktiske)
16. mars 2018
Studiet fullført (Faktiske)
16. mars 2018
Datoer for studieregistrering
Først innsendt
25. juni 2014
Først innsendt som oppfylte QC-kriteriene
1. august 2014
Først lagt ut (Anslag)
5. august 2014
Oppdateringer av studieposter
Sist oppdatering lagt ut (Faktiske)
5. august 2019
Siste oppdatering sendt inn som oppfylte QC-kriteriene
1. august 2019
Sist bekreftet
1. august 2019
Mer informasjon
Begreper knyttet til denne studien
Nøkkelord
Ytterligere relevante MeSH-vilkår
Andre studie-ID-numre
- APAP-21014
Denne informasjonen ble hentet direkte fra nettstedet clinicaltrials.gov uten noen endringer. Hvis du har noen forespørsler om å endre, fjerne eller oppdatere studiedetaljene dine, vennligst kontakt register@clinicaltrials.gov. Så snart en endring er implementert på clinicaltrials.gov, vil denne også bli oppdatert automatisk på nettstedet vårt. .
Kliniske studier på Obstruktiv søvnapné
-
University of Wisconsin, MadisonPhilips HealthcareFullførtSøvn, Slow-wave Sleep, Sleep Enhancement, Sleep Optimization
-
National University of SingaporeRekrutteringReduksjon av skjermbruk + Sleep Extension | FrilevendeSingapore
-
Northwell HealthJazz PharmaceuticalsRekrutteringElektrisk status Epilepticus of Slow-Wave SleepForente stater
-
Brigham and Women's HospitalAktiv, ikke rekrutterendeSøvnforstyrrelser, iboende | Søvnforstyrrelser, døgnrytme | Advanced Sleep Phase Syndrome (ASPS) | Forsinket søvnfasesyndrom | Skift-arbeid søvnforstyrrelse | Forsinket søvnfase | Ikke-24 timers søvn- og våkneforstyrrelse | Advanced Sleep Phase Syndrome | Avansert søvnfase | Uregelmessig søvn-våkne-syndrom | Skift...Forente stater
-
Brigham and Women's HospitalCharite University, Berlin, Germany; Stanford UniversityRekrutteringSøvnforstyrrelser, iboende | Søvnvåkenforstyrrelser | Søvnforstyrrelser, døgnrytme | Advanced Sleep Phase Syndrome (ASPS) | Forsinket søvnfasesyndrom | Skift-arbeid søvnforstyrrelse | Forsinket søvnfase | Ikke-24 timers søvn- og våkneforstyrrelse | Advanced Sleep Phase Syndrome | Avansert søvnfase | Uregelmessig... og andre forholdForente stater
-
Brigham and Women's HospitalStanford UniversityRekrutteringSøvnvåkenforstyrrelser | Søvnforstyrrelse | Søvnforstyrrelser, døgnrytme | Døgnrytmeforstyrrelser | Døgnrytme søvnforstyrrelse | Advanced Sleep Phase Syndrome (ASPS) | Forsinket søvnfasesyndromForente stater
-
Tyco Healthcare GroupUkjent
-
Maastricht University Medical CenterEpilepsiecentrum KempenhaegheFullførtRolandsk epilepsi | Landau-Kleffners syndrom | Nattlig frontallappepilepsi | Elektrisk status Epilepticus under Slow Wave SleepNederland
Kliniske studier på Positive airway pressure for the treatment of OSA
-
Memorial Sloan Kettering Cancer CenterAvsluttetFamiliene eller pårørende til pasienter behandlet ved MSKCC for ikke-kutane plateepitelkarsinomer i | Øvre fordøyelseskanalForente stater
-
Wake Forest University Health SciencesFullførtGynekologisk kreft | Seksuell dysfunksjonForente stater
-
H. Lee Moffitt Cancer Center and Research InstitutePfizerAktiv, ikke rekrutterendeNyrecellekarsinom stadium IVForente stater
-
Groupe Hospitalier de la Region de Mulhouse et...Fullført
-
H. Lee Moffitt Cancer Center and Research InstituteKite, A Gilead CompanyAktiv, ikke rekrutterendeDiffust storcellet B-celle lymfom | Transformert lymfomForente stater