Nasal Expiratory Positive Airway Pressure for the Treatment of Pediatric Obstructive Sleep Apnea Syndrome

NCT ID: NCT01768065

Last Updated: 2019-09-10

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: EARLY_PHASE1
• Total Enrollment: 15 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2012-07-31
• Study Completion Date: 2013-04-30

Brief Summary

This study will evaluate effectiveness and adherence of the nasal expiratory positive airway pressure (NEPAP) device as an an alternate therapy for children with Obstructive Sleep Apnea Syndrome (OSAS). NEPAP is currently approved for use only in adults.

Detailed Description

The nasal expiratory positive airway pressure (NEPAP) device has been used to treat OSAS in adults. A disposable device is placed in each nostril at night and attached with adhesive. The device acts as a one-way valve, during inspiration the valve opens, with negligible resistance to flow. During expiration, the valve closes and airflow is directed through small air channels, increasing resistance. The increased resistance helps to maintain the upper airway pressure during the critical end-expiratory period when the upper airway has been found to be most narrow in the breaths preceding an apnea event. In contrast to Continuous Positive Airway Pressure (CPAP) which provides positive pressure during both inspiration and expiration, NEPAP creates pressure during expiration. NEPAP is a potential alternative therapy which is less cumbersome than CPAP and may increase adherence.

Conditions

Organic Pediatric Obstructive Sleep Apnea

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: CROSSOVER
• Primary Study Purpose: TREATMENT
• Blinding Strategy: TRIPLE

Study Groups

Nasal Expiratory Positive Airway Pressure Devices

Nasal Expiratory Positive Airway Pressure Device

Group Type: EXPERIMENTAL

Nasal Expiratory Positive Airway Pressure Device

Intervention Type: DEVICE

assigned to Nasal Expiratory Positive Airway Pressure arm

placebo sham

A sham device

Group Type: SHAM_COMPARATOR

placebo sham

Intervention Type: DEVICE

Interventions

Nasal Expiratory Positive Airway Pressure Device

assigned to Nasal Expiratory Positive Airway Pressure arm

Intervention Type: DEVICE

placebo sham

Intervention Type: DEVICE

Eligibility Criteria

Inclusion Criteria

1. Subjects age 5-16 years (note: Due to the size of the devices, it is expected that most children will be at least 8 years old, but a few may be younger. Subjects will be evaluated in clinic to fit for size and habituate to the device)

2. OSAS (AHI > 5/hr)

3. Subject has had adenotonsillectomy or is not a candidate for adenotonsillectomy

4. Subject is non-adherent to CPAP or is seeking an alternative therapy

5. Tolerance of NEPAP device during a daytime session

6. Parental/guardian permission (informed consent) and if appropriate, child assent.

Exclusion Criteria

1. Severe developmental delay thought to involve a high risk of aspiration

2. Family does not understand English well enough to perform the standardized, validated questionnaires.

3. Age >16 years since results may be similar to adult studies in these older patients.

4. Severe breathing disorder (including respiratory muscle weakness, bullous lung disease, bypassed upper airway, pneumothorax, pneumomediastinum)

5. Severe heart disease (including heart failure)

6. An acute upper respiratory (including nasal, sinus or middle ear) inflammation or infection or perforation of the ear drum

Subjects that do not meet all of the enrollment criteria will not be enrolled. Any violations of these criteria will be reported in accordance with Institutional Review Board (IRB) Policies and Procedures.

Study members will not recruit females who are known to be pregnant. However, if a subject becomes pregnant during the study, we will continue to use the device. Pregnancy is not an exclusion criterion as positive airway pressure therapy does not harm the pregnant woman or fetus.

• Minimum Eligible Age: 5 Years
• Maximum Eligible Age: 16 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: Yes

Sponsors

Children's Hospital of Philadelphia

OTHER

Sponsor Role: lead

Responsible Party

Ignacio Tapia, MD

Principal Investigator

Responsibility Role: PRINCIPAL_INVESTIGATOR

Principal Investigators

Carole Marcus

Role: PRINCIPAL_INVESTIGATOR

Children's Hospital of Philadelphia

Locations

Children's Hospital of Philadelphia

Philadelphia, Pennsylvania, United States

Countries

United States

References

Kureshi SA, Gallagher PR, McDonough JM, Cornaglia MA, Maggs J, Samuel J, Traylor J, Marcus CL. Pilot study of nasal expiratory positive airway pressure devices for the treatment of childhood obstructive sleep apnea syndrome. J Clin Sleep Med. 2014 Jun 15;10(6):663-9. doi: 10.5664/jcsm.3796.

Reference Type: DERIVED

PMID: 24932147 (View on PubMed)

Other Identifiers

12-008691

Identifier Type: -

Identifier Source: org_study_id