Polysomnographic assessment of automatic adjustable vs fixed EPAP intelligent volume assured positive airway pressure support in chronic hypoventilation

Introduction: An intelligent volume assured positive airway pressure support device has recently been developed to automatically adjust expiratory positive airway pressure (iVAPS AutoEPAP, ResMed Ltd., Bella Vista, Australia). Aims: To evaluate efficacy of the iVAPS AutoEPAP algorithm compared to iVAPS FixedEPAP in treating chronic hypoventilation. Methods: Randomized, double-blind, cross-over, non-inferiority trial of AutoEPAP vs FixedEPAP iVAPSon sleep and breathing over 2 nights of attended polysomnography (PSG). FixedEPAP was determined at a preceding PSG. Results: 25 adults (COPD=11, obesity hypoventilation=9, neuromuscular disease=5) aged 57±7yrs, established on non-invasive ventilation ≥3 months and apnoea/hypopnoea index (AHI)>5.There were no statistical differences between the AutoEPAP and FixedEPAP iVAPS for measures of sleep disordered breathing (Table). All other sleep parameters, including patient mode preference, were equivalent between the two modes. Conclusions: TheiVAPS AutoEPAP algorithm demonstrated equivalent treatment of breathing and sleep parameters to iVAPS FixedEPAP in chronic hypoventilation patients over the course of a single night9s therapy. Advantages over manual titration include ease of implementation of therapy and continuous overnight autotitration to optimise upper airway control.