a pilot study to assess the effects of a novel application of averaged volume assured pressure support ventilation (avaps-ae) therapy on re-hospitalization in patients with sleep-disordered breathing with co-morbid copd

Conditions: Breathing-Related Sleep Disorder

Summary: this is a multicenter, randomized, parallel-group, open label study of the efficacy of avaps-ae to prevent re-hospitalization in hospitalized patients with comorbid chronic obstructive pulmonary disease (copd).

this is a multicenter, randomized, parallel-group, open label study of the efficacy of avaps-ae to prevent re-hospitalization in hospitalized patients with comorbid copd. hospitalized patients with comorbid copd who are at high risk for readmission will be recruited. specifically patients with comorbid copd who are to be discharged with (a) admission diagnosis of copd (gold stage ii or greater); and (b) either a prior non-elective hospitalization (one in the past 12 months) or active smoker. such participants will undergo questionnaire-based screening for sleep-disordered breathing (stop-bang questionnaire) and if they have a high risk for sleep disordered breathing (sdb) (\> 3 points) will undergo an overnight portable sleep study for screening prior to hospital discharge (ahi \> 10 per hour; \>3% oxygen desaturation for hypopneas). after randomization and prior to discharge, participants will either be initiated on avaps-ae therapy (intervention arm) for 60 days or will be referred to the sleep center for further diagnostic testing and therapy initiation (standard of care arm). participants will complete quality of life questionnaires functional outcomes of sleep questionnaire (fosq) at baseline (in-person), and in 30 and 60 days (by mail) post discharge. information regarding hospital admission, diagnostic tests, medication changes, and procedures will be collected from all participants. discharge summaries of re-hospitalizations and office or er visits, as well as diagnostics tests and therapies received will be collected for measuring healthcare costs. participants will have an option to enroll in a registry for a 3 year follow-up and will also be queried on a yearly basis regarding hospitalizations, cardiovascular events, and assessment of vital statistics in the national death index registry. the study will conclude when all randomized participants have been followed for a minimum of 60 days.

Eligibility criteria:
inclusion criteria: 1. hospitalized patients who are at high risk for readmission who are at least 18 years of age. 2. specifically patients with (a) admission diagnosis of copd and (b) either a prior non-elective hospitalization (one in the past 12 months) or active smoker who are ready for discharge and (c) are also found to have sleep-disordered breathing (ahi ≥ 10 per hour; \>3% oxygen desaturation for hypopneas) by overnight portable respiratory study prior to hospital discharge. 3. bedside spirometry revealing evidence for obstructive lung disease (post-bronchodilator; gold stage ii or greater (fev1 \<70% predicted post bd). 4. no previous home positive airway pressure (pap) or non- invasive ventilation (niv) use within the past year exclusion criteria: 1. central sleep apnea (central apnea index \>5 per hour; and/or \>50% are central apneas \& hypopneas) 2. clinically unstable, i.e., acute respiratory failure, hypotensive shock, uncontrolled cardiac ischemia or arrhythmias, requiring life support ventilation or as otherwise determined by the investigator 3. participants with stage iii \& iv chronic heart failure as defined by the new york heart association (nyha) classification 4. known or expected contraindications for the use of non-invasive ventilation per the assessment of the investigator. 5. lack of medical insurance