title: Nasal Expiratory Positive Airway Pressure Devices (Provent) for OSA: A Systematic Review and Meta-Analysis.
abstract: Objective. To quantify the effectiveness of nasal expiratory positive airway pressure (nasal EPAP) devices or Provent as treatment for obstructive sleep apnea (OSA). Methods. PubMed and six other databases were searched through November 15, 2015, without language limitations. Results. Eighteen studies (920 patients) were included. Pre- and post-nasal EPAP means ± standard deviations (M ± SD) for apnea-hypopnea index (AHI) in 345 patients decreased from 27.32 ± 22.24 to 12.78 ± 16.89 events/hr (relative reduction = 53.2%). Random effects modeling mean difference (MD) was -14.78 events/hr [95% CI -19.12, -10.45], p value < 0.00001. Oxygen desaturation index (ODI) in 247 patients decreased from 21.2 ± 19.3 to 12.4 ± 14.1 events/hr (relative reduction = 41.5%, p value < 0.00001). Lowest oxygen saturation (LSAT) M ± SD improved in 146 patients from 83.2 ± 6.8% to 86.2 ± 11.1%, MD 3 oxygen saturation points [95% CI 0.57, 5.63]. Epworth Sleepiness Scale (ESS) M ± SD improved (359 patients) from 9.9 ± 5.3 to 7.4 ± 5.0, MD -2.5 [95% CI -3.2, -1.8], p value < 0.0001. Conclusion. Nasal EPAP (Provent) reduced AHI by 53.2%, ODI by 41.5% and improved LSAT by 3 oxygen saturation points. Generally, there were no clear characteristics (demographic factors, medical history, and/or physical exam finding) that predicted favorable response to these devices. However, limited evidence suggests that high nasal resistance could be associated with treatment failure. Additional studies are needed to identify demographic and polysomnographic characteristics that would predict therapeutic success with nasal EPAP (Provent).
authors.affiliation: Twin Cities Community Hospital, Templeton, CA 93465, USA.
authors.forename: Muhammad
authors.initials: M
authors.lastname: Riaz
authors.affiliation: Department of Otorhinolaryngology, Sleep Medicine Centre, Hospital CUF, 4100-180 Porto, Portugal; Centre for Research in Health Technologies and Information Systems (CINTESIS), University of Porto, 4200-450 Porto, Portugal.
authors.forename: Victor
authors.initials: V
authors.lastname: Certal
authors.affiliation: Clay County Hospital, 911 Stacy Burk Drive, Flora, IL 62839, USA.
authors.forename: Gaurav
authors.initials: G
authors.lastname: Nigam
authors.affiliation: Department of Otorhinolaryngology, Hospital Bernardino Rivadavia, Buenos Aires, Argentina.
authors.forename: Jose
authors.initials: J
authors.lastname: Abdullatif
authors.affiliation: Department of Head and Neck Surgery, University of California, Los Angeles, CA 90095, USA.
authors.forename: Soroush
authors.initials: S
authors.lastname: Zaghi
authors.affiliation: Sleep Medicine Division, Department of Psychiatry and Behavioral Sciences, Stanford Hospital and Clinics, Redwood City, CA 94063, USA.
authors.forename: Clete A
authors.initials: CA
authors.lastname: Kushida
authors.affiliation: Sleep Medicine Division, Department of Psychiatry and Behavioral Sciences, Stanford Hospital and Clinics, Redwood City, CA 94063, USA; Division of Otolaryngology, Sleep Surgery, and Sleep Medicine, Tripler Army Medical Center (Tripler AMC), 1 Jarrett White Road, Honolulu, HI 96859, USA.
authors.forename: Macario
authors.initials: M
authors.lastname: Camacho