Source: International Congress 2016 – Treatment options for obstructive sleep apnoea and obesity hypoventilation
Disease area: Sleep and breathing disorders

Abstract

Automatic bilevel ventilation (AutoBI) has been recently introduced to treat obstructive sleep-disordered breathing (SDB), but clinical experience is still limited. We revised the charts of patients treated for obstructive SDB in our sleep clinic in 2015 (n=214) to assess the frequency of trials of AutoBI ventilators (ResMed Auto25 or Respironics BiFlex), the clinical characteristics of these patients, the reason to shift from CPAP to AutoBI, and the outcome of AutoBI titration. A trial of domiciliary AutoBI was made in 44 patients (20.5%) intolerant to CPAP due to high CPAP levels (n=11) or who showed incomplete resolution of SDB on CPAP (n=33). The table reports the clinical data according to diagnosis.

Diagnosis	OSA (n=19, 6F)	OHS (n=11, 7F)	OSA+COPD Overlap (n=14, 3F)
Age (yrs)	62.5 ± 9.3	56.3 ± 10.8	65.3 ± 8.5
BMI (kg/m2)	41.4 ± 9.1	48.3 ± 18.0	33.9 ± 4.4
AHI	60.9 ± 28.7	38.0 ± 17.1	34.9 ± 18.5
cumulative time at SaO2<90% (CT90%) (%)	38.7 ± 23.8	68.2 ± 32.7	49.5 ± 27.2
CPAP pressure (n)	7	1	3
CPAP ineffective (n)	12	10	11

 

AutoBi was successful (i.e. resolution of SDB and improved CT90%/daytime arterial blood gases) in 34 patients (77%), and failed in 10 patients (4 OHS, 3 OSA and 3 overlap). Patients successfully treated were significantly less obese (BMI 37.9±6.8 kg/m²) than patients showing failure of AutoBi (n=10, BMI 50.2±20.1 kg/m², p=0.0035). Failure of AutoBi was mostly seen among patients with incomplete resolution of SDB, only one overlap patient being intolerant to high CPAP pressure. Our results suggest that AutoBi is an effective alternative treatment in patients with obstructive SDB, especially in patients intolerant to high CPAP and without extreme obesity or COPD.


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Pierpaolo Baiamonte (Palermo, Italy), Pierpaolo Baiamonte, Claudia I. Gruttad’Auria, Emilia Mazzuca, Alessandra Castrogiovanni, Mario Spatafora, Maria R. Bonsignore. Automatic bilevel ventilation in sleep-disordered breathing: A real-life experience in southern Italy. Eur Respir J 2016; 48: Suppl. 60, 3425

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