OSA Recurrence in CPAP Withdrawal
Condition: OSA
MeSH terms: Recurrence
Study type: Interventional

Summary: 
      Continuous positive airway pressure (CPAP) therapy is the most effective Treatment for
      obstructive sleep apnoea (OSA ). However, adherence to CPAP is often limited. There are
      established and emerging treatment alternatives to CPAP available, however, they are usually
      less effective than CPAP. To develop novel treatment methods and to predict who will respond
      to which treatment, the mechanism underlying obstructive sleep apnoea and different patient
      types should be described. Especially the contribution of the upper airway function and
      central respiratory control should be studied for this purpose. In a prospective
      interventional study, patients with OSA effectively treated with CPAP will undergo
      physiologic measurements during a two week period off CPAP to define the pathophysiological
      mechanisms associated with OSA recurrence. This knowledge could facilitate individually
      tailored treatment and improve therapy adherence and patient outcomes.
    

Detailed description: 
      Obstructive sleep apnoea (OSA) is a highly prevalent sleep-related breathing disorder
      characterised by a repetitive collapse of the pharynx during sleep, which results in apnoea
      or hypopnoea associated with oxygen desaturations and arousal from sleep. Continuous positive
      airway pressure (CPAP) is the gold standard treatment. Treatment success depends on regular
      CPAP usage. However, low adherence to CPAP is a frequent problem. It has recently been shown
      that OSA does not re-occur immediately in all OSA patients upon CPAP therapy withdrawal and
      that there are different patterns of recurrence of OSA as indicated by repeated sleep
      studies. So far, the mechanisms of OSA recurrence upon CPAP therapy withdrawal are
      incompletely understood. Upper airway collapsibility and neuromuscular tone, pharyngeal
      oedema and inflammation, neural respiratory drive, sleep stage and position may play a role.

      In a prospective interventional study, patients with OSA effectively treated with CPAP will
      undergo physiologic measurements during a two week period off CPAP to define the
      pathophysiological mechanisms associated with OSA recurrence. In particular, we will
      investigate the effects of CPAP withdrawal on neural respiratory drive and upper airway
      function. Inpatient sleep studies and assessments will be performed at baseline (day 0) on
      CPAP and at follow-up upon CPAP withdrawal (day 14). At the end of the trial patients will
      return to their established CPAP therapy.

      We hypothesise that CPAP withdrawal results in different patterns of OSA recurrence defined
      by neural respiratory drive and upper airway function. The aim of the proposed project is to
      study the mechanisms of OSA recurrence by using a validated CPAP withdrawal model. Knowledge
      on recurrence patterns and different phenotypes of OSA could facilitate individually tailored
      treatment of OSA and improved therapy adherence and patient outcomes.
    

Intervention name(s): CPAP withdrawal
Intervention type(s): Other
Intervention description(s): Short-term withdrawal of CPAP therapy in moderate to severe OSA
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Diagnostic
Keywords: OSA; CPAP; upper airway collapse; neural respiratory drive