- Largest-ever analysis of patients with treatment-emergent
central sleep apnea shows switching from CPAP to ASV significantly
improves compliance
- Study highlights the need to consider therapeutic options
based on each patient's disease severity
MARSEILLES, France,
April 6, 2017 /PRNewswire/
-- ResMed Inc. (NYSE: RMD) today announced that people with
obstructive sleep apnea who develop central sleep apnea (CSA) are
more compliant on therapy after they switch from continuous
positive airway pressure (CPAP) therapy to adaptive
servo-ventilation (ASV) therapy, according to the largest-ever
analysis of patients with treatment-emergent CSA.
Experience the interactive Multimedia News Release here:
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The study analyzed anonymous, aggregated data from the devices
of 198,890 telemonitored patients in the
United States who were receiving positive airway pressure
therapy for their sleep apnea. It showed that those with
treatment-emergent CSA who switched from CPAP to ASV used their
therapy longer and had significantly fewer apneas (breathing
stoppages or reductions) during sleep:
- 62.7 percent: Patients' compliance on CPAP prior to
switching
- 76.6 percent: The same patients' compliance after switching to
ASV
"Achieving compliance through proper therapy usage is a
well-recognized clinical goal in sleep apnea management, and one
that is often hard to achieve, particularly in difficult-to-treat
patients who may have untreated central sleep apnea," said
Carlos Nunez, M.D., ResMed's Chief
Medical Officer. "These findings underscore the importance of
continuously monitoring central sleep apnea and rethinking the
conventional wisdom on therapeutic options based on each patient's
disease severity."
The study results were presented in an abstract at The European
Respiratory Society and European Society of Sleep Research 2017
Sleep and Breathing conference in Marseilles, France. The opinion leaders and experts in the
author group for the study include:
- Jean-Louis Pépin from Institut National de la Santé et de la
Recherche Médicale (INSERM), U 1042, HP2 Laboratory (Hypoxia:
Pathophysiology), Grenoble Alpes University, Grenoble, France
- Peter Cistulli from Charles
Perkins Centre, University of Sydney,
and Royal North Shore Hospital, Sydney,
Australia
- Atul Malhotra from University of California San Diego, La Jolla, California, USA
About the study
This retrospective analysis compared
compliance rates of 198,890 patients using anonymous, aggregated
telemonitoring data from a U.S. positive airway pressure (PAP)
therapy database. Three groups of patients were analyzed for
compliance, device usage, and measures of disease severity: Those
patients that started and stayed on CPAP (the "CPAP-only" group),
patients that started and stayed on ASV (the "ASV-only" group), and
patients that started on CPAP and switched to ASV (the "Switch"
group). All patients in the analysis received CPAP via ResMed's
AirSense™ 10 or ASV via ResMed's AirCurve™ 10 devices.
Compliance and device usage
The study used the U.S. Medicare definition of compliance:
device usage for more than four hours per night on 70 percent of
nights during a consecutive 30-day period anytime during the first
three months of initial use.
In the "Switch" group, patients beginning on CPAP had the lowest
initial compliance rate at 62.7 percent, but improved to 76.6
percent after switching to ASV. The low initial compliance seen in
the Switch patients is possibly due to untreated CSA, based on
their overall higher AHI – specifically their central apnea index
(CAI) – during week one of therapy compared to the CPAP-only group.
The 90-day compliance rates seen for the CPAP-only and ASV-only
groups were 73.8 percent and 73.2 percent, respectively. In the
Switch group, average residual AHI also decreased significantly
(reduction from 17.2±0.9/h to 4.4±0.3/h) after the switch,
indicating that ASV reduced both obstructive and central
events.
Mean device usage at 90 days was similar for ASV in the Switch
group with a rate of 5.73 hours per day, compared to 5.27 and 5.31
for the CPAP-only and ASV-only groups, respectively.
About sleep-disordered breathing
Sleep-disordered
breathing encompasses a spectrum of breathing problems during
sleep, including sleep apnea, a condition that results in
repetitive pauses in breathing during sleep. The two most common
types are obstructive sleep apnea (OSA) and central sleep apnea
(CSA). OSA is a sleep disorder in which the throat muscles relax,
block the airways and stop the flow of breath during sleep. CSA is
a sleep disorder in which the brain does not transmit the "breathe"
signal to the muscles that control breathing during
sleep.
In both OSA and CSA, the lack of oxygen causes the person to
wake up and start breathing again, interrupting continuous
sleep.
CSA specifically has been linked to a variety of diseases and
conditions: It has been observed to develop over time –
particularly in patients on CPAP for OSA who have a history of
ischemic stroke or have taken opioids for chronic pain – making it
difficult to treat.
About ResMed
ResMed (NYSE: RMD) changes lives with
award-winning medical devices and cutting-edge cloud-based software
applications that better diagnose, treat and manage sleep apnea,
chronic obstructive pulmonary disease (COPD) and other chronic
diseases. ResMed is a global leader in connected care, with more
than 2 million patients remotely monitored every day. Our
5,000-strong team is committed to creating the world's best
tech-driven medical device company – improving quality of life,
reducing the impact of chronic disease, and saving healthcare costs
in more than 100 countries.
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