Retrospective, nonrandomized controlled study on autoadjusting, dual-pressure positive airway pressure therapy for a consecutive series of complex insomnia disorder patients

Barry Krakow,1–3 Natalia D McIver,1,2 Victor A Ulibarri,1,2 Michael R Nadorff4,5 1Sleep & Human Health Institute, 2Maimonides Sleep Arts & Sciences, Ltd, Albuquerque, 3Los Alamos Medical Center, Los Alamos, NM, 4Department of Psychology, Mississippi State Universit...

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Autores principales:	Krakow B, McIver ND, Ulibarri VA, Nadorff MR
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2017
Materias:	insomnia obstructive sleep apnea upper airway resistance syndrome CPAP failure auto-bilevel adaptive servo-ventilation Psychiatry RC435-571 Neurophysiology and neuropsychology QP351-495
Acceso en línea:	https://doaj.org/article/9e65bb3a7c9a4638af93cb12e785c801
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spelling	oai:doaj.org-article:9e65bb3a7c9a4638af93cb12e785c8012021-12-02T03:49:08ZRetrospective, nonrandomized controlled study on autoadjusting, dual-pressure positive airway pressure therapy for a consecutive series of complex insomnia disorder patients1179-1608https://doaj.org/article/9e65bb3a7c9a4638af93cb12e785c8012017-03-01T00:00:00Zhttps://www.dovepress.com/retrospective-nonrandomized-controlled-study-on-autoadjusting-dual-pre-peer-reviewed-article-NSShttps://doaj.org/toc/1179-1608Barry Krakow,1–3 Natalia D McIver,1,2 Victor A Ulibarri,1,2 Michael R Nadorff4,5 1Sleep & Human Health Institute, 2Maimonides Sleep Arts & Sciences, Ltd, Albuquerque, 3Los Alamos Medical Center, Los Alamos, NM, 4Department of Psychology, Mississippi State University, Mississippi, MS, 5Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA Purpose: Emerging evidence shows that positive airway pressure (PAP) treatment of obstructive sleep apnea (OSA) and upper airway resistance syndrome (UARS) in chronic insomnia patients (proposed “complex insomnia” disorder) leads to substantial decreases in insomnia severity. Although continuous PAP (CPAP) is the pressure mode most widely researched, intolerance to fixed pressurized air is rarely investigated or described in comorbidity patients. This retrospective study examined dual pressure, autoadjusting PAP modes in chronic, complex insomnia disorder patients.Patients and methods: Chronic insomnia disorder patients (mean [SD] insomnia severity index [ISI] =19.11 [3.34]) objectively diagnosed with OSA or UARS and using either autobilevel PAP device or adaptive servoventilation (ASV) device after failing CPAP therapy (frequently due to intolerance to pressurized air, poor outcomes, or emergence of CSA) were divided into PAP users (≥20 h/wk) and partial users (<20 h/wk) for comparison. Subjective and objective baseline and follow-up measures were analyzed.Results: Of the 302 complex insomnia patients, PAP users (n=246) averaged 6.10 (1.78) nightly hours and 42.71 (12.48) weekly hours and partial users (n=56) averaged 1.67 (0.76) nightly hours and 11.70 (5.31) weekly hours. For mean (SD) decreases in total ISI scores, a significant (group × time) interaction was observed (F[1,300]=13.566; P<0.0001) with PAP users (–7.59 [5.92]; d=1.63) showing superior results to partial users (-4.34 [6.13]; d=0.81). Anecdotally, patients reported better tolerability with advanced PAP compared to previous experience with CPAP. Both adaptive servoventilation and autobilevel PAP showed similar ISI score improvement without statistical differences between devices. Total weekly hours of PAP use correlated inversely with change in insomnia symptoms (r=-0.256, P<0.01).Conclusion: Insomnia severity significantly decreased in patients using autoadjusting PAP devices, but the study design restricts interpretation to an association. Future research must elucidate the interaction between insomnia and OSA/UARS as well as the adverse influence of pressure intolerance on PAP adaptation in complex insomnia patients. Randomized controlled studies must determine whether advanced PAP modes provide benefits over standard CPAP modes in these comorbidity patients. Keywords: insomnia, obstructive sleep apnea, upper airway resistance syndrome, CPAP failure, autobilevel, adaptive servoventilationKrakow BMcIver NDUlibarri VANadorff MRDove Medical Pressarticleinsomniaobstructive sleep apneaupper airway resistance syndromeCPAP failureauto-bileveladaptive servo-ventilationPsychiatryRC435-571Neurophysiology and neuropsychologyQP351-495ENNature and Science of Sleep, Vol Volume 9, Pp 81-95 (2017)
institution	DOAJ
collection	DOAJ
language	EN
topic	insomnia obstructive sleep apnea upper airway resistance syndrome CPAP failure auto-bilevel adaptive servo-ventilation Psychiatry RC435-571 Neurophysiology and neuropsychology QP351-495
spellingShingle	insomnia obstructive sleep apnea upper airway resistance syndrome CPAP failure auto-bilevel adaptive servo-ventilation Psychiatry RC435-571 Neurophysiology and neuropsychology QP351-495 Krakow B McIver ND Ulibarri VA Nadorff MR Retrospective, nonrandomized controlled study on autoadjusting, dual-pressure positive airway pressure therapy for a consecutive series of complex insomnia disorder patients
description	Barry Krakow,1–3 Natalia D McIver,1,2 Victor A Ulibarri,1,2 Michael R Nadorff4,5 1Sleep & Human Health Institute, 2Maimonides Sleep Arts & Sciences, Ltd, Albuquerque, 3Los Alamos Medical Center, Los Alamos, NM, 4Department of Psychology, Mississippi State University, Mississippi, MS, 5Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA Purpose: Emerging evidence shows that positive airway pressure (PAP) treatment of obstructive sleep apnea (OSA) and upper airway resistance syndrome (UARS) in chronic insomnia patients (proposed “complex insomnia” disorder) leads to substantial decreases in insomnia severity. Although continuous PAP (CPAP) is the pressure mode most widely researched, intolerance to fixed pressurized air is rarely investigated or described in comorbidity patients. This retrospective study examined dual pressure, autoadjusting PAP modes in chronic, complex insomnia disorder patients.Patients and methods: Chronic insomnia disorder patients (mean [SD] insomnia severity index [ISI] =19.11 [3.34]) objectively diagnosed with OSA or UARS and using either autobilevel PAP device or adaptive servoventilation (ASV) device after failing CPAP therapy (frequently due to intolerance to pressurized air, poor outcomes, or emergence of CSA) were divided into PAP users (≥20 h/wk) and partial users (<20 h/wk) for comparison. Subjective and objective baseline and follow-up measures were analyzed.Results: Of the 302 complex insomnia patients, PAP users (n=246) averaged 6.10 (1.78) nightly hours and 42.71 (12.48) weekly hours and partial users (n=56) averaged 1.67 (0.76) nightly hours and 11.70 (5.31) weekly hours. For mean (SD) decreases in total ISI scores, a significant (group × time) interaction was observed (F[1,300]=13.566; P<0.0001) with PAP users (–7.59 [5.92]; d=1.63) showing superior results to partial users (-4.34 [6.13]; d=0.81). Anecdotally, patients reported better tolerability with advanced PAP compared to previous experience with CPAP. Both adaptive servoventilation and autobilevel PAP showed similar ISI score improvement without statistical differences between devices. Total weekly hours of PAP use correlated inversely with change in insomnia symptoms (r=-0.256, P<0.01).Conclusion: Insomnia severity significantly decreased in patients using autoadjusting PAP devices, but the study design restricts interpretation to an association. Future research must elucidate the interaction between insomnia and OSA/UARS as well as the adverse influence of pressure intolerance on PAP adaptation in complex insomnia patients. Randomized controlled studies must determine whether advanced PAP modes provide benefits over standard CPAP modes in these comorbidity patients. Keywords: insomnia, obstructive sleep apnea, upper airway resistance syndrome, CPAP failure, autobilevel, adaptive servoventilation
format	article
author	Krakow B McIver ND Ulibarri VA Nadorff MR
author_facet	Krakow B McIver ND Ulibarri VA Nadorff MR
author_sort	Krakow B
title	Retrospective, nonrandomized controlled study on autoadjusting, dual-pressure positive airway pressure therapy for a consecutive series of complex insomnia disorder patients
title_short	Retrospective, nonrandomized controlled study on autoadjusting, dual-pressure positive airway pressure therapy for a consecutive series of complex insomnia disorder patients
title_full	Retrospective, nonrandomized controlled study on autoadjusting, dual-pressure positive airway pressure therapy for a consecutive series of complex insomnia disorder patients
title_fullStr	Retrospective, nonrandomized controlled study on autoadjusting, dual-pressure positive airway pressure therapy for a consecutive series of complex insomnia disorder patients
title_full_unstemmed	Retrospective, nonrandomized controlled study on autoadjusting, dual-pressure positive airway pressure therapy for a consecutive series of complex insomnia disorder patients
title_sort	retrospective, nonrandomized controlled study on autoadjusting, dual-pressure positive airway pressure therapy for a consecutive series of complex insomnia disorder patients
publisher	Dove Medical Press
publishDate	2017
url	https://doaj.org/article/9e65bb3a7c9a4638af93cb12e785c801
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_version_	1718401608071512064

Retrospective, nonrandomized controlled study on autoadjusting, dual-pressure positive airway pressure therapy for a consecutive series of complex insomnia disorder patients

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