title: Role of nasal positive end expiratory pressure valve as an alternative treatment for obstructive sleep apnoea in Chinese patients.
abstract: OBJECTIVE
  As compliance of continuous positive airway pressure (CPAP) for treatment of obstructive sleep apnoea (OSA) is often suboptimal, a less cumbersome treatment is desirable. We explored the clinical usefulness of nasal positive end expiratory pressure (nPEEP) valves.
  
  
  METHODS
  Symptomatic OSA patients (apnoea hypopnea index (AHI) >5/h by polysomnography (PSG) or >10/h by type III devices), who declined CPAP, were recruited. A nPEEP valve was attached to each nostril before bed. After successful acclimatization for 1 week, treatment was continued for 4 weeks. The nPEEP valves provided expiratory resistance to build up PEEP. PSG was performed at week 4.
  
  
  RESULTS
  Among 196 subjects, 46 (23%) failed acclimatization and 14 (7%) withdrew. Among the 120 patients with a valid PSG, 72 (60%) and 75 (63%) had >50% reduction in mean (standard deviation) overall AHI 26 (16)/h to 18 (18)/h and mean supine AHI 31 (19)/h to 11(16)/h, respectively, P < 0.001. Compared with responders, patients with <50% reduction in AHI had a higher mean overall AHI (30/h vs 23/h, P = 0.03), higher mean supine AHI (35/h vs 26/h, P = 0.04), more severe mean oxygen desaturation nadir (76.7% vs 82.7%, P < 0.01) and longer mean period of desaturation <90% SaO2 (7.7 vs 2.4, P = 0.02). Breathing discomfort and dry mouth were the most common side effects. Compared with a dental device, there was a larger mean reduction in supine AHI using nPEEP (29 (14)/h vs 16 (17)/h).
  
  
  CONCLUSIONS
  nPEEP valves were useful in selected patients with mild or positional-related OSA.
authors.affiliation: Division of Respiratory Medicine, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong.
authors.forename: Kin Wang
authors.initials: KW
authors.lastname: To
authors.affiliation: Division of Respiratory Medicine, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong.
authors.forename: Tat O
authors.initials: TO
authors.lastname: Chan
authors.affiliation: Division of Respiratory Medicine, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong.
authors.forename: Susana
authors.initials: S
authors.lastname: Ng
authors.affiliation: Division of Respiratory Medicine, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong.
authors.forename: Jenny
authors.initials: J
authors.lastname: Ngai
authors.affiliation: Division of Respiratory Medicine, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong.
authors.forename: David Sc
authors.initials: DS
authors.lastname: Hui
mesh_terms: D002681:China / Q000453:epidemiology; D045422:Continuous Positive Airway Pressure / Q000379:methods*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D017286:Polysomnography; D018467:Positive-Pressure Respiration, Intrinsic / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D020181:Sleep Apnea, Obstructive / Q000150:complications / Q000453:epidemiology / Q000628:therapy*
keywords: continuous positive airway pressure; dental device; obstructive sleep apnoea; positive end expiratory pressure; treatment