therapap adherence crossover study

Conditions: Obstructive Sleep Apnea

Summary: therapap is a novel therapy approach being developed by sleepres, llc. for the treatment of obstructive sleep apnea (osa). this algorithm has been integrated into the sefam s.box cpap (continuous positive airway pressure) device and both standard cpap/apap (auto-titrated pap) as well as therapap can be delivered. therapap is a pressure control algorithm that lowers the pressure from the set pressure at the beginning of inspiration and does not return the pressure to the full set level until some point in late expiration. in this randomized crossover study, the comparative adherence to therapy between therapap and apap will be compared. each therapy will be used by the patient for six-week periods with randomly assigned order, and the usage during each arm will be compared.

the therapap adherence study is a randomized, crossover study in treatment naive participants with osa in which the adherence to therapy will be compared between therapap and standard apap. because all participants will breathe on both therapy types and those therapy types are individually unique in feel, blinding is not possible. participants will be chosen from a pool of patients who are pap-naïve and who have received either a psg (in-lab polysomnogram), split-night study (in-lab psg and pressure titration) or home sleep study (hst) within the previous 3 months. upon signing an informed consent, participants will be randomly assigned to start on either the therapap or apap arms when they arrive at the office to pick up their sefam s.box with therapap algorithms integrated. each participant will then be given their new equipment and will be trained in proper use for both arms of the study so that they will not need to appear at the office again until the study is completed. in both the apap and therapap arms, participants will have their therapy set to 5-20 cmh2o for three nights. the pressure range will then be narrowed to ± 2 cmh2o around their 95% pressure level as assessed during the third night. this same pressure range will be used during the second arm for each patient. within the therapap arm, participants will be set to a double comfort setting drop according to the following table. this drop schedule will be implemented even while the therapap device is operating with automatic pressure adjustment. pset drop 1 drop 2 5.0 - 5.9 0 0 6.0 - 6.9 1 0 7.0 - 7.9 2 0 8.0 - 8.9 2 1 9.0 - 9.9 2 2 10.0 - 20.0 2 3 participants will use their starting therapy nightly at home for 6 weeks after which time they will undergo a washout period of 1 week where no therapy will be used. following the washout period, they will initiate another 6-week usage with the second therapy. afterward, they will return to the office to receive their permanent equipment. phone calls as reminders to end the first arm, start the washout period, then to start the second arm will be made. immediately after both arms of the study are completed, the following will occur: * eligibility criteria will be reviewed and confirmed * participants will be asked to respond to the following ess (epworth sleepiness scale) fosq (functional outcomes of sleep questionnaire) during the home use period, subjects will be called at the following time points during each arm of the study. at each time point, adverse events and compliance with the device will be assessed. subjects using the device less than an average of 5 hours per night during the first week will be contacted on a more regular basis (weekly until 5 hour per night use is achieved) to address any problems and encourage use. if patients discontinue use of the device during the home use period, they will still be encouraged to return for all testing per protocol. if a patient refuses to come in for further testing, they will be considered a lost to follow up and excluded from efficacy analysis.

Eligibility criteria:
inclusion criteria: 1. ahi \> 10 on a previous psg or hst (hypopneas requiring 4% desaturation). 2. central apneas \< 25% of events 3. plm (periodic limb movements) arousal index \< 15 exclusion criteria: 1. a female of child-bearing potential that is pregnant or intends to become pregnant. 2. any unstable or severe medical condition of any organ system including congestive heart failure, copd, renal failure, neuromuscular disease, etc., or at the discretion of the site principal investigator (pi). 3. taking medication that may affect sleep, sleepiness, or alertness including hypnotics, sedatives, alerting agents, stimulants, anticonvulsants, etc. 4. the presence of any other sleep disorder (insomnia, periodic limb movement disorder, etc). 5. prior therapy or treatment for osa. 6. chronic oxygen therapy. 7. excessive alcohol consumption (\>14 drinks/week). 8. the use of any illegal drug(s). 9. any condition that in the investigator's opinion would present an unreasonable risk to the participant, or which would interfere with their participation in the study or confound study interpretation.