OSA recurrence in CPAP withdrawal
Research type
Research Study
Full title
Pathophysiology of obstructive sleep apnoea recurrence during continuous positive airway pressure therapy withdrawal
IRAS ID
237921
Contact name
Joerg Steier
Contact email
Sponsor organisation
Guys and St Thomas NHS Foundation Trust
Duration of Study in the UK
1 years, 4 months, 30 days
Research summary
Obstructive sleep apnoea is a common sleep-related breathing disorder characterised by repetitive collapse of the upper airway during sleep resulting in apnoeas (“breathing pauses”) and associated drops in oxygen saturation. The typical symptoms are snoring, unrefreshing sleep and excessive daytime sleepiness, affecting work, social life and memory. If left untreated for years, it also puts patients at risk of having high blood pressure, heart attack and stroke. The most effective treatment for obstructive sleep apnoea is continuous positive airway pressure (CPAP). However, not everyone tolerates this treatment because it requires to sleep with a mask that is connected by a tube to a machine providing positive pressure to prevent upper airway collapse during sleep. Although CPAP is recommended for moderate or severe obstructive sleep apnoea, approximately half of the patients do not use the treatment in the long-term.
The study design includes a two week CPAP therapy withdrawal to study the recurrence pattern of obstructive sleep apnoea. We hypothesise that CPAP withdrawal results in different patterns of recurrence of sleep apnoea defined by the drive to breath and upper airway function. This knowledge could facilitate individually tailored treatment and improve therapy adherence and patient outcomes.
The primary outcome of this study is the drive to breath, which is measured by electromyography (EMG). It is a measure of the balance between the load on respiratory muscles and their capacity to compensate the load and provides information on your central respiratory control. It can be non-invasively measured by placing electrodes (the same as are used for an electrocardiogram of the heart) on the skin without causing any pain or sensation to the participant. Additionally, the drive to breath can be measured by a EMG catheter inserted into the oesophagus via a nostril (this is not mandatory for the study).
The CPAP withdrawal model is a validated and effective model to study pathophysiology of obstructive sleep apnoea or potential treatment alternatives to CPAP (Kohler M et al, AJRCCM 2011) in a controlled way in a population of well characterised patients.
REC name
North West - Liverpool Central Research Ethics Committee
REC reference
18/NW/0114
Date of REC Opinion
29 Mar 2018
REC opinion
Further Information Favourable Opinion