Skip to main content
Log in

A review of EPAP nasal device therapy for obstructive sleep apnea syndrome

Sleep and Breathing Aims and scope Submit manuscript

Abstract

Background

Expiratory positive airway pressure (EPAP) nasal devices provide a new therapeutic option for obstructive sleep apnea (OSA).

Methods

Here, we review the literature about treatment of OSA with EPAP, which has been shown to reduce the apnea/hypopnea index (AHI) and daytime sleepiness.

Results

Patients generally prefer EPAP to continuous positive airway pressure (CPAP), and there are no serious adverse effects from its use. Although CPAP more effectively improves sleep apnea, a recent study showed similar outcomes in symptom improvement using EPAP. Patients with mild to moderate OSA who do not tolerate CPAP are appropriate candidates for EPAP. However, there are few well-designed clinical trials that evaluate efficacy.

Conclusions

More studies are needed to assess the efficacy of and compliance with EPAP nasal devices, to define which patients will benefit from EPAP therapy, and to compare EPAP to other alternative OSA therapies.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Jordan AS, McSharry DG, Malhotra A (2014) Adult obstructive sleep apnoea. Lancet 383:736–747

    Article  PubMed Central  PubMed  Google Scholar 

  2. Teran-Santos J, Jimenez-Gomez A, Cordero-Guevara J (1999) The association between sleep apnea and the risk of traffic accidents. Cooperative Group Burgos-Santander. N Engl J Med 340:847–851

    Article  CAS  PubMed  Google Scholar 

  3. Engleman HM, Douglas NJ (2004) Sleep. 4: sleepiness, cognitive function, and quality of life in obstructive sleep apnoea/hypopnoea syndrome. Thorax 59:618–622

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  4. Peppard PE, Young T, Palta M, Skatrud J (2000) Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med 342:1378–1384

    Article  CAS  PubMed  Google Scholar 

  5. Wang H, Parker JD, Newton GE, Floras JS, Mak S, Chiu KL, Ruttanaumpawan P, Tomlinson G, Bradley TD (2007) Influence of obstructive sleep apnea on mortality in patients with heart failure. J Am Coll Cardiol 49:1625–1631

    Article  PubMed  Google Scholar 

  6. Bradley TD, Floras JS (2009) Obstructive sleep apnoea and its cardiovascular consequences. Lancet 373:82–93

    Article  PubMed  Google Scholar 

  7. Kasai T, Floras JS, Bradley TD (2012) Sleep apnea and cardiovascular disease: a bidirectional relationship. Circulation 126:1495–1510

    Article  PubMed  Google Scholar 

  8. Omachi TA, Claman DM, Blanc PD, Eisner MD (2009) Obstructive sleep apnea: a risk factor for work disability. Sleep 32:791–798

    PubMed Central  PubMed  Google Scholar 

  9. Mulgrew AT, Ryan CF, Fleetham JA, Cheema R, Fox N, Koehoorn M, Fitzgerald JM, Marra C, Ayas NT (2007) The impact of obstructive sleep apnea and daytime sleepiness on work limitation. Sleep Med 9:42–53

    Article  CAS  PubMed  Google Scholar 

  10. Qaseem A, Holty JE, Owens DK, Dallas P, Starkey M, Shekelle P (2013) Management of obstructive sleep apnea in adults: a clinical practice guideline from the American College of Physicians. Ann Intern Med 159:471–483

    PubMed  Google Scholar 

  11. Chasens ER, Pack AI, Maislin G, Dinges DF, Weaver TE (2005) Claustrophobia and adherence to CPAP treatment. West J Nurs Res 27:307–321

    Article  PubMed  Google Scholar 

  12. Parthasarathy S, Haynes PL, Budhiraja R, Habib MP, Quan SF (2006) A national survey of the effect of sleep medicine specialists and American Academy of Sleep Medicine Accreditation on management of obstructive sleep apnea. J Clin Sleep Med 2:133–142

    PubMed  Google Scholar 

  13. Veasey SC, Guilleminault C, Strohl KP, Sanders MH, Ballard RD, Magalang UJ (2006) Medical therapy for obstructive sleep apnea: a review by the Medical Therapy for Obstructive Sleep Apnea Task Force of the Standards of Practice Committee of the American Academy of Sleep Medicine. Sleep 29:1036–1044

    PubMed  Google Scholar 

  14. Sawyer AM, Gooneratne NS, Marcus CL, Ofer D, Richards KC, Weaver TE (2011) A systematic review of CPAP adherence across age groups: clinical and empiric insights for developing CPAP adherence interventions. Sleep Med Rev 15:343–356

    Article  PubMed Central  PubMed  Google Scholar 

  15. Gotsopoulos H, Chen C, Qian J, Cistulli PA (2002) Oral appliance therapy improves symptoms in obstructive sleep apnea: a randomized, controlled trial. Am J Respir Crit Care Med 166:743–748

    Article  PubMed  Google Scholar 

  16. Aarab G, Lobbezoo F, Hamburger HL, Naeije M (2011) Oral appliance therapy versus nasal continuous positive airway pressure in obstructive sleep apnea: a randomized, placebo-controlled trial. Respiration 81:411–419

    Article  PubMed  Google Scholar 

  17. Engleman HM, McDonald JP, Graham D, Lello GE, Kingshott RN, Coleman EL, Mackay TW, Douglas NJ (2002) Randomized crossover trial of two treatments for sleep apnea/hypopnea syndrome: continuous positive airway pressure and mandibular repositioning splint. Am J Respir Crit Care Med 166:855–859

    Article  PubMed  Google Scholar 

  18. Barnes M, McEvoy RD, Banks S, Tarquinio N, Murray CG, Vowles N, Pierce RJ (2004) Efficacy of positive airway pressure and oral appliance in mild to moderate obstructive sleep apnea. Am J Respir Crit Care Med 170:656–664

    Article  PubMed  Google Scholar 

  19. De Dios JA, Brass SD (2012) New and unconventional treatments for obstructive sleep apnea. Neurotherapeutics 9:702–709

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  20. Mahadevia AK, Onal E, Lopata M (1983) Effects of expiratory positive airway pressure on sleep-induced respiratory abnormalities in patients with hypersomnia-sleep apnea syndrome. Am Rev Respir Dis 128:708–711

    CAS  PubMed  Google Scholar 

  21. Colrain IM, Brooks S, Black J (2008) A pilot evaluation of a nasal expiratory resistance device for the treatment of obstructive sleep apnea. J Clin Sleep Med 4:426–433

    PubMed Central  PubMed  Google Scholar 

  22. Rosenthal L, Massie CA, Dolan DC, Loomas B, Kram J, Hart RW (2009) A multicenter, prospective study of a novel nasal EPAP device in the treatment of obstructive sleep apnea: efficacy and 30-day adherence. J Clin Sleep Med 5:532–537

    PubMed Central  PubMed  Google Scholar 

  23. Walsh JK, Griffin KS, Forst EH, Ahmed HH, Eisenstein RD, Curry DT, Hall-Porter JM, Schweitzer PK (2011) A convenient expiratory positive airway pressure nasal device for the treatment of sleep apnea in patients non-adherent with continuous positive airway pressure. Sleep Med 12:147–152

    Article  PubMed  Google Scholar 

  24. Berry RB, Kryger MH, Massie CA (2011) A novel nasal expiratory positive airway pressure (EPAP) device for the treatment of obstructive sleep apnea: a randomized controlled trial. Sleep 34:479–485

    PubMed Central  PubMed  Google Scholar 

  25. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP, Clarke M, Devereaux PJ, Kleijnen J, Moher D (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ 339:b2700

    Article  PubMed Central  PubMed  Google Scholar 

  26. Patel AV, Hwang D, Masdeu MJ, Chen GM, Rapoport DM, Ayappa I (2011) Predictors of response to a nasal expiratory resistor device and its potential mechanisms of action for treatment of obstructive sleep apnea. J Clin Sleep Med 7:13–22

    PubMed Central  PubMed  Google Scholar 

  27. Braga CW, Chen Q, Burschtin OE, Rapoport DM, Ayappa I (2011) Changes in lung volume and upper airway using MRI during application of nasal expiratory positive airway pressure in patients with sleep-disordered breathing. J Appl Physiol (1985) 111:1400–1409

    Article  CAS  Google Scholar 

  28. Xie A, Rankin F, Rutherford R, Bradley TD (1997) Effects of inhaled CO2 and added dead space on idiopathic central sleep apnea. J Appl Physiol (1985) 82:918–926

    CAS  Google Scholar 

  29. Owens RL, Malhotra A, Eckert DJ, White DP, Jordan AS (2010) The influence of end-expiratory lung volume on measurements of pharyngeal collapsibility. J Appl Physiol (1985) 108:445–451

    Article  Google Scholar 

  30. Lo YL, Jordan AS, Malhotra A, Wellman A, Heinzer RC, Schory K, Dover L, Fogel RB, White DP (2006) Genioglossal muscle response to CO2 stimulation during NREM sleep. Sleep 29:470–477

    PubMed Central  PubMed  Google Scholar 

  31. Heinzer RC, Stanchina ML, Malhotra A, Jordan AS, Patel SR, Lo YL, Wellman A, Schory K, Dover L, White DP (2006) Effect of increased lung volume on sleep disordered breathing in patients with sleep apnoea. Thorax 61:435–439

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  32. Kryger MH, Berry RB, Massie CA (2011) Long-term use of a nasal expiratory positive airway pressure (EPAP) device as a treatment for obstructive sleep apnea (OSA). J Clin Sleep Med 7:449–453

    PubMed Central  PubMed  Google Scholar 

  33. Rossi VA, Winter B, Rahman NM, Yu LM, Fallon J, Clarenbach CF, Bloch KE, Stradling JR, Kohler M (2013) The effects of Provent on moderate to severe obstructive sleep apnoea during continuous positive airway pressure therapy withdrawal: a randomised controlled trial. Thorax 68:854–859

    Article  PubMed  Google Scholar 

  34. Troxel WM, Conrad TS, Germain A, Buysse DJ (2013) Predictors of treatment response to Brief Behavioral Treatment of Insomnia (BBTI) in older adults. J Clin Sleep Med 9:1281–1289

    PubMed Central  PubMed  Google Scholar 

  35. Weaver TE, Laizner AM, Evans LK, Maislin G, Chugh DK, Lyon K, Smith PL, Schwartz AR, Redline S, Pack AI, Dinges DF (1997) An instrument to measure functional status outcomes for disorders of excessive sleepiness. Sleep 20:835–843

    CAS  PubMed  Google Scholar 

  36. Kureshi SA, Gallagher PR, McDonough JM, Cornaglia MA, Maggs J, Samuel J, Traylor J, Marcus CL (2014) Pilot study of nasal expiratory positive airway pressure devices for the treatment of childhood obstructive sleep apnea syndrome. J Clin Sleep Med 10:663–669

    PubMed Central  PubMed  Google Scholar 

  37. Alves C, Caminha JM, Da SA, Mendonca D (2012) Compliance to continuous positive airway pressure therapy in a group of Portuguese patients with obstructive sleep apnea syndrome. Sleep Breath 16:555–562

    Article  PubMed  Google Scholar 

  38. Abdelghani A, Slama S, Hayouni A, Harrabi I, Mezghanni S, Garrouche A, Klabi N, Benzarti M, Jerray M (2009) Acceptance and long-term compliance to continuous positive airway pressure in obstructive sleep apnea. A prospective study on 72 patients treated between 2004 and 2007. Rev Pneumol Clin 65:147–152

    Article  CAS  PubMed  Google Scholar 

  39. Wolkove N, Baltzan M, Kamel H, Dabrusin R, Palayew M (2008) Long-term compliance with continuous positive airway pressure in patients with obstructive sleep apnea. Can Respir J 15:365–369

    PubMed Central  PubMed  Google Scholar 

Download references

Funding source

Capital Health Development Special Scientific Research Projects No. 2011-2003-05.

Conflict of interest

The authors declare no conflicts of interest.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Yongxiang Wei.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wu, H., Yuan, X., Zhan, X. et al. A review of EPAP nasal device therapy for obstructive sleep apnea syndrome. Sleep Breath 19, 769–774 (2015). https://doi.org/10.1007/s11325-014-1057-y

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11325-014-1057-y

Keywords

Navigation