An expiratory positive airway pressure valve applied nasally (proventTM) improves polysomnographic indices of obstructive sleep apnoea severity in a clinical practice case series.

Abstract

Introduction: Expiratory Positive Airway Pressure (EPAP) valves have been shown in RCTs to improve OSA severity (1). However implementation into clinical practice has been mixed. Clinicians may be unclear on optimal target groups and long term outcome. In contrast to earlier studies, a recent unpublished RCT of EPAP failed to show efficacy (2) adding to uncertainty.We report our early experience of EPAP in clinical practice. Method(s): Patients who were offered EPAP (ProventTM) as first line treatment for mild to moderate obstructive sleep apnoea (OSA) or as salvage treatment in severe OSA who failed/refused CPAP were included. Following 10 day minimum home trial, patients who tolerated the device were invited to confirm efficacy with EPAP PSG. Result(s): (Table Presented) Conclusion(s): EPAP showed a significant reduction in AHI, most effective for lateral sleep and least for supine REM.We failed to show a significant improvement in ODI or ESS. The reasons for the improvement in AHI, but not ODI require further exploration. Options include nasal EPAP being preferentially effective for mild obstructive events, or due to the inability of the custom fitted nasal recording cannula to accurately measure nasal airflow.