Automatic positive airway pressure may be used as alternative therapy amongst bariatric patients with obstructive sleep apnea

1. In this randomized controlled trial, there was no significant difference in adherence between automatic positive airway pressure therapy (APAP) compared to continuous positive airway pressure therapy (CPAP) amongst patients with obstructive sleep apnea (OSA) awaiting bariatric surgery.

2. There was no significant difference in efficacy of treatment or safety profile between CPAP or APAP therapy.

Evidence Rating Level: 1 (Excellent)

Obstructive sleep apnea (OSA) is a condition prevalent amongst the bariatric population characterized by dynamic upper airway obstruction during sleep. Continuous positive airway pressure (CPAP) therapy is an effective treatment, however patients often fail therapy because of discomfort and inability to sleep. Automatic positive airway pressure (APAP) therapy may be better tolerated in certain patients. The objective of this study was to compare adherence to APAP with CPAP therapies amongst obese patients with OSA awaiting bariatric surgery.

In this randomized controlled trial, obese patients with newly diagnosed OSA awaiting bariatric surgery were included. Patients with a diagnosis of severe cardiovascular, respiratory, or neurological disease, as well as central sleep apnea were excluded. Fifty participants were randomized in a 1:1 ratio to either APAP therapy or CPAP therapy. Study outcomes assessed difference in adherence to APAP and CPAP, as well as treatment efficacy, adverse effects, quality of life, and adherence at one month.

In this study, there was a significant difference in compliance to therapy when expressed as a percentage of overall nights therapy was used (96.9% adherence to APAP compared to 86% adherence to CPAP, p = 0.47). However, in terms of percentage of nights with longer than 4 hour use, there was no significant difference in adherence to either therapy.  Furthermore, there was no significant difference in adherence at one month, treatment efficacy, adverse effects, peri-operative complications, or quality of life. This study was limited as it was underpowered in assessing peri-operative complications. Furthermore, considering imminent bariatric surgery is an incentive for patients to adhere to OSA therapy, the results of this study may not be extrapolated. Nonetheless, this study suggested there was no difference in adherence to APAP versus CPAP therapy amongst OSA patients awaiting bariatric surgery.

Click to read the study in Journal of Sleep Research

Image: PD 

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