Obstructive Sleep Apnea Clinical Trial
— DOTOfficial title:
Dual Obstructive Sleep Apnea (OSA) Therapy (MAS With PAP)
Verified date | April 2018 |
Source | University of British Columbia |
Contact | n/a |
Is FDA regulated | No |
Health authority | |
Study type | Interventional |
Continuous positive airway pressure (CPAP) is considered the gold standard therapy for
obstructive sleep apnea (OSA). However, CPAP users sometimes experience pressure-related
discomfort. It is thought that lower CPAP pressure may increase comfort and lead to greater
treatment adherence.
Mandibular advancement splint (MAS) therapy has been shown to be the preferred OSA treatment
option among patients. However, MAS therapy is only partially effective in some OSA patients,
especially in severe cases.
It is thought that a combination of MAS and PAP therapy may benefit patients in which MAS
alone is only partially effective. Using MAS and PAP at the same time is called "Dual
Therapy". Dual Therapy may allow a lower CPAP pressure to be applied, which may increase
patient comfort and therefore increase treatment adherence and overall effectiveness.
This study will evaluate the effectiveness of 1 month of Dual Therapy in 30 OSA patients.
Status | Enrolling by invitation |
Enrollment | 30 |
Est. completion date | December 2018 |
Est. primary completion date | October 2018 |
Accepts healthy volunteers | No |
Gender | All |
Age group | 19 Years to 80 Years |
Eligibility |
Inclusion Criteria: - Age 19-80 years old who are able to freely provide informed consent; - Prior participation in the CHOICE study; - Have been optimally titrated to PAP and MAS therapy; - Have both PAP and MAS appliances at home and ready for use; - Body mass index (BMI) of 35 or less; - = 8 teeth per arch to support treatment with MAS; - Have an objective of diagnosis of OSA based on the following criteria: - - an Apnea-Hypopnea Index (AHI) within the range 10 = AHI = 70 documented with polysomnography in the last 2 years; ***OR*** - - a Respiratory Disturbance Index (RDI) within the range 20 = RDI = 70 documented with level III portable sleep test; ***OR*** - - an Oxygen Desaturation Index (ODI) = 10; - Sleep investigations confirming the object diagnosis of OSA have been performed within the past 4 years Exclusion Criteria: - Use of a full face mask as the PAP interface; - Extensive periodontal disease with significant tooth mobility; - Inability to protrude jaw; - Insufficient vertical opening to accommodate treatment with MAS; - Uncontrolled congestive heart failure (defined as a prior clinical diagnosis, an ejection cut-off of 40% or clinical sign in the opinion of a primary care physician or cardiologist) that makes it unsafe in the opinion of the investigators for the subject to participate in the trial; - Coronary artery disease unless stable for at least 6 months and considered by the investigators to have a stable disease; - Any history of angina, myocardial infarction or stroke; - Any history of major depressive disorder along with current moderate-severe disease; - Active cancer management (unless in remission for more than 1 year); - Known renal failure (with need for dialysis); - History of a near miss or prior automobile accident due to sleepiness within the past 12 months; - At nighttime, 30% of the night is at = 90% oxygen saturation levels. |
Country | Name | City | State |
---|---|---|---|
Canada | Université de Montréal | Montréal | Quebec |
Canada | University of British Columbia | Vancouver | British Columbia |
Lead Sponsor | Collaborator |
---|---|
University of British Columbia | Université de Montréal |
Canada,
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | Change in CPAP Pressure | Optimal CPAP Pressure determined by the Respiratory Therapist (cmH2O) | Baseline (from previous treatment with CPAP) and 1 month after commencing Dual Therapy treatment. | |
Primary | Comfort | A subjective assessment of the Dual Therapy treatment, reported via a questionnaire. | Baseline (from previous treatment) and 1 month after commencing Dual Therapy treatment. | |
Primary | Treatment Adherence (hrs/night) | Adherence measured in hours per night. | The duration of Dual Therapy treatment (1 month). | |
Primary | Treatment Adherence (% nights) | Adherence measured in percentage of nights of use. | The duration of Dual Therapy treatment (1 month). | |
Secondary | Daytime Sleepiness | Evaluation of OSA specific fatigue using Epworth Sleepiness Scale (ESS) questionnaire. ESS measures daytime sleepiness via 8 questions that ask about daytime sleepiness during common everyday conditions. The potential range of scores for any questions is from 0 to 3. Higher values represent worse outcomes. Their are no subscales for ESS. The answers to the questions are all summed up. Total score ranges between 0 and 24. A score above 10 indicates daytime sleepiness with higher scores indicating more sleepiness. | Baseline (from previous treatment) and 1 month after commencing Dual Therapy treatment. | |
Secondary | Quality of Life using Functional Outcomes of Sleep Questionnaire (FOSQ-10) | FOSQ-10 measures functional status and difficulty in performing everyday activities via 10 questions. The range of scores for any question is from 1 to 4. There is also a 0 score option for participants who do not engage in a particular activity for other reasons, in which case the question will be excluded. There are 5 subscales that measure: general productivity, activity level, vigilance, social outcomes, and intimacy and sexual relationships. To obtain the total score, a mean-weighted item score is computed for those subscales with more than one item. To calculate a mean-weighted item score calculate the mean of the answered items with responses > 1 for each subscale. The total score is then derived by calculating the mean of the subscale scores and multiplying that mean by five. Total score ranges between 5 and 20. Higher scores indicate better functional status. | Baseline (from previous treatment) and 1 month after commencing Dual Therapy treatment. | |
Secondary | Efficacy - Oxygen Desaturation Index | The number of times per hour of sleep that the blood's oxygen level drop below 97% oxygen saturation. | Baseline (from previous treatment) and 1 month after commencing Dual Therapy treatment. | |
Secondary | Efficacy - Time below 90% Saturation | Percentage of time during sleep that the patient's blood oxygen levels fall below 90% saturation. | Baseline (from previous treatment) and 1 month after commencing Dual Therapy treatment. | |
Secondary | Efficacy - Minimum Saturation | The lowest percentage saturation of the patient's blood oxygen levels during sleep. | Baseline (from previous treatment) and 1 month after commencing Dual Therapy treatment. |
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