Role of nasal positive end expiratory pressure valve as an alternative treatment for obstructive sleep apnoea in C hinese patients

Background and objective A s 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 (n PEEP ) 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 n PEEP 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% SaO 2 (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 n PEEP (29 (14)/h vs 16 (17)/h). Conclusion nPEEP valves were useful in selected patients with mild or positional‐related OSA .