Determination of Upper Airway Collapsibility During Routine CPAP Titration

NCT02566278 | Terminated

• 1 other identifier: UCSD151355
• Study Type: interventional
• Target: 20
• Locations: 1 country
• Sites: 1

Brief Summary

The investigators hypothesis is that upper airway collapsibility (Pcrit) in patients with obstructive sleep apnea (OSA) can be measured using equipment found in the clinical sleep laboratory and these Pcrit measurements obtained using clinical sleep laboratory equipment is comparable to those obtained using research equipment. OSA is a common disease characterized by repetitive collapse of the upper airway during sleep, leading to hypoxemia and arousals, and which has important neurocognitive and cardiovascular consequences. The single most important factor in the development of OSA is upper airway collapsibility: those with a more collapsible upper airway tend to have OSA while those with a stiffer upper airway do not. The gold standard treatment for OSA is continuous positive airway pressure (CPAP), which acts by stenting open the collapsible airway. Upper airway collapsibility can be measured during sleep by changing the CPAP level and assessing the change in inspiratory flow through the upper airway. Although technically feasible, these measurements are typically only undertaken in research laboratories with specialized equipment. The purpose of this study is to measure upper airway collapsibility using clinically available (i.e. equipment found in a clinical sleep laboratory) equipment only. If successful, upper airway collapsibility could be routinely measured in clinical practice, which could help inform treatment decisions and help individualize therapy for OSA.

Conditions

Obstructive Sleep Apnea

Keywords

Obstructive Sleep Apnea; Pcrit; Upper airway collapsibility

Outcome Measures

Primary Outcomes (1)

• Passive critical closing pressure (Pcrit)

  Upper airway collapsibility, as measured by critical closing pressure (Pcrit), defined as the maximum nasal pressure at which the upper airway occludes.

  Baseline

Study Arms (1)

Obstructive Sleep Apnea

EXPERIMENTAL

Upper airway collapsibility (passive Pcrit) will be measured using both clinically available equipment and research equipment in patients with obstructive sleep apnea (OSA) and stable on treatment of continuous positive airway pressure (CPAP) \> 3 months to verify the Pcrit measurement obtained by the clinical equipment.

Other: Upper airway collapsibility (Pcrit)

Interventions

Upper airway collapsibility (Pcrit) OTHER

To measure passive Pcrit, patients sleep with a mask over their nose or nose and mouth, and CPAP is applied using a custom made machine that can rapidly change mask pressures in research setting. The idea is that rapid changes in airway pressure produce a clear step change in airflow that will be observed quickly. In contrast, during clinical titrations, the CPAP machines change pressure much more slowly to help promote patient comfort. Passive Pcrit will be measured using both research and clinical equipment in the same patients and the Pcrit result using clinical CPAP titration equipment will be compared to the gold standard: Pcrit measurement done through research equipment that changes CPAP pressure rapidly.

Obstructive Sleep Apnea

Eligibility Criteria

• Age: 18 Years - 79 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Diagnosis of OSA and stable on CPAP treatment \> 3 months

You may not qualify if:

• Pregnancy
• Currently smoking
• Any respiratory disorder other than OSA or well controlled asthma
• Medications known to affect respiratory function (e.g. opioids, benzodiazepines, etc)

Sponsors & Collaborators

• University of California, San Diego: lead

Study Sites (1)

University of California, San Diego

San Diego, California, 92093, United States

Location

Related Publications (5)

• Malhotra A, Orr JE, Owens RL. On the cutting edge of obstructive sleep apnoea: where next? Lancet Respir Med. 2015 May;3(5):397-403. doi: 10.1016/S2213-2600(15)00051-X. Epub 2015 Apr 14.

  PMID: 25887980 BACKGROUND

• Wei T, Erlacher MA, Grossman P, Leitner EB, McGinley BM, Patil SP, Smith PL, Schneider H, Schwartz AR, Kirkness JP. Approach for streamlining measurement of complex physiological phenotypes of upper airway collapsibility. Comput Biol Med. 2013 Jun;43(5):600-6. doi: 10.1016/j.compbiomed.2012.12.006. Epub 2013 Mar 18.

  PMID: 23517555 BACKGROUND

• Owens RL, Edwards BA, Eckert DJ, Jordan AS, Sands SA, Malhotra A, White DP, Loring SH, Butler JP, Wellman A. An Integrative Model of Physiological Traits Can be Used to Predict Obstructive Sleep Apnea and Response to Non Positive Airway Pressure Therapy. Sleep. 2015 Jun 1;38(6):961-70. doi: 10.5665/sleep.4750.

  PMID: 25515107 BACKGROUND

• Eckert DJ, White DP, Jordan AS, Malhotra A, Wellman A. Defining phenotypic causes of obstructive sleep apnea. Identification of novel therapeutic targets. Am J Respir Crit Care Med. 2013 Oct 15;188(8):996-1004. doi: 10.1164/rccm.201303-0448OC.

  PMID: 23721582 BACKGROUND

• Owens RL, Malhotra A, Eckert DJ, White DP, Jordan AS. The influence of end-expiratory lung volume on measurements of pharyngeal collapsibility. J Appl Physiol (1985). 2010 Feb;108(2):445-51. doi: 10.1152/japplphysiol.00755.2009. Epub 2009 Nov 25.

  PMID: 19940097 BACKGROUND

MeSH Terms

Conditions

Sleep Apnea, Obstructive

Condition Hierarchy (Ancestors)

Sleep Apnea Syndromes; Apnea; Respiration Disorders; Respiratory Tract Diseases; Sleep Disorders, Intrinsic; Dyssomnias; Sleep Wake Disorders; Nervous System Diseases

Study Officials

• Robert Owens, MD

  University of California, San Diego

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: NA
• Masking: NONE
• Purpose: DIAGNOSTIC
• Intervention Model: SINGLE GROUP
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Assistant Professor

Study Record Dates

• First Submitted: September 26, 2015
• First Posted: October 2, 2015
• Study Start: October 20, 2015
• Primary Completion: July 25, 2016
• Study Completion: July 25, 2016
• Last Updated: July 10, 2019

Record last verified: 2019-07

Locations

US (1)