title: Efficacy of Bilevel-auto Treatment in Patients with Obstructive Sleep Apnea Not Responsive to or Intolerant of Continuous Positive Airway Pressure Ventilation.
abstract: BACKGROUND
  Ventilation with continuous positive airway pressure (CPAP) is the gold standard therapy for obstructive sleep apnea (OSA). However, it was recently suggested that a novel mode of ventilation, Bilevel-auto, could be equally effective in treating patients unable to tolerate CPAP. The aim of this study was to investigate the ability of Bilevel-auto to treat OSA patients whose nocturnal ventilatory disturbances are not completely corrected by CPAP.
  
  
  METHODS
  We enrolled 66 consecutive OSA patients, not responsive to (group A) or intolerant of (group B) CPAP treatment, after a full night of manual CPAP titration in a laboratory. Full polysomnography data and daytime sleepiness score were compared for each group in the three different conditions: basal, during CPAP, and during Bilevel-auto.
  
  
  RESULTS
  The apnea-hypopnea index decreased significantly during CPAP in both groups; however, in the group A, there was a further significant improvement during Bilevel-auto. The same trend was observed for oxygenation indices, while the distribution and the efficiency of sleep did not differ following the switch from CPAP to Bilevel-auto.
  
  
  CONCLUSIONS
  This study confirmed the role of Bilevel-auto as an effective therapeutic alternative to CPAP in patients intolerant of this latter mode of ventilation. Moreover, extending the use of Bilevel-auto to those OSA patients not responsive to CPAP, we showed a significantly better correction of nocturnal respiratory disturbances.
authors.affiliation: Pulmonary Rehabilitation, Fondazione Salvatore Maugeri IRCCS - Scientific Institute of Pavia, Pavia, Italy.
authors.forename: Annalisa
authors.initials: A
authors.lastname: Carlucci
authors.affiliation: Pulmonary Rehabilitation, Fondazione Salvatore Maugeri IRCCS - Scientific Institute of Pavia, Pavia, Italy.
authors.forename: Piero
authors.initials: P
authors.lastname: Ceriana
authors.affiliation: Pulmonary Rehabilitation, Fondazione Salvatore Maugeri IRCCS - Scientific Institute of Pavia, Pavia, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Mancini
authors.affiliation: Pulmonary Rehabilitation, Fondazione Salvatore Maugeri IRCCS - Scientific Institute of Pavia, Pavia, Italy.
authors.forename: Serena
authors.initials: S
authors.lastname: Cirio
authors.affiliation: Department of Thoracic Medicine, St. Vincent's Hospital, Darlinghurst NSW, Australia.
authors.forename: Paola
authors.initials: P
authors.lastname: Pierucci
authors.affiliation: Sleep Medicine Unit, Fondazione Salvatore Maugeri IRCCS - Scientific Institute of Pavia, Pavia, Italy.
authors.forename: Nadia
authors.initials: N
authors.lastname: D'Artavilla Lupo
authors.affiliation: Sleep Medicine Unit, Fondazione Salvatore Maugeri IRCCS - Scientific Institute of Pavia, Pavia, Italy.
authors.forename: Felice
authors.initials: F
authors.lastname: Gadaleta
authors.affiliation: Sleep Medicine Unit, Fondazione Salvatore Maugeri IRCCS - Scientific Institute of Pavia, Pavia, Italy.
authors.forename: Elisa
authors.initials: E
authors.lastname: Morrone
authors.affiliation: Sleep Medicine Unit, Fondazione Salvatore Maugeri IRCCS - Scientific Institute of Pavia, Pavia, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Fanfulla
mesh_terms: D045422:Continuous Positive Airway Pressure; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017286:Polysomnography; D012121:Respiration, Artificial / Q000379:methods*; D020181:Sleep Apnea, Obstructive / Q000628:therapy*; D012894:Sleep Stages; D016896:Treatment Outcome
keywords: Bilevel-auto; COPD; CPAP; noninvasive ventilation; obesity; sleep; sleep apnea