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NCT01368614

AVAPS-AE Efficacy Study

Completed NA Results posted Last updated 26 April 2019
What this trial tests

NA trial testing AVAPS-AE Mode of Therapy in Obesity Hypoventilation Syndrome in 90 participants. Completed in 30 May 2013.

Timeline
12 September 2011
Primary endpoint
30 May 2013
30 May 2013

Quick facts

Lead sponsorPhilips Respironics
PhaseNA
StatusCompleted
Study typeINTERVENTIONAL
Allocationrandomized
Designparallel
Maskingsingle
Primary purposetreatment
Enrollment90
Start date12 September 2011
Primary completion30 May 2013
Estimated completion30 May 2013
Sites2 locations across United States

Drugs / interventions tested

Conditions studied

Sponsor

Philips Respironics

Who can join

Adults 18 to 70, any sex, with Obesity Hypoventilation Syndrome. Patients with the condition only — healthy volunteers not accepted.

Results — posted to ClinicalTrials.gov

Per-arm endpoint measurements with 95% confidence intervals where reported. Source: trial results section.

Daytime Partial Pressure of Carbon Dioxide in Arterial Blood (PaCO2) Primary · Screening & 6 weeks

Daytime PaCO2 measurements will be assessed for all randomized patients to each mode of ventilation therapy (AVAPS-AE, bilevel PSV, CPAP) after 6 weeks.

Screening
GroupValue95% CI
AVAPS-AE47.1± 2.5
Respironics OmniLab Advanced BiPAP S Mode51.8± 8.0
Respironics OmniLab Advanced CPAP Mode50.7± 4.7
Week 6
GroupValue95% CI
AVAPS-AE40.7± 3.7
Respironics OmniLab Advanced BiPAP S Mode47.4± 8.9
Respironics OmniLab Advanced CPAP Mode40.8± 5.8
Daytime Partial Pressure of Oxygen in Arterial Blood(Pa02) Secondary · Screening & 6 weeks

Daytime Pa02 measurements will be assessed for all randomized patients to each mode of ventilation therapy (AVAPS-AE, bilevel PSV, CPAP) after 6 weeks.

Screening
GroupValue95% CI
AVAPS-AE62.8± 5.8
Respironics OmniLab Advanced BiPAP S Mode56.9± 10.7
Respironics OmniLab Advanced CPAP Mode62.6± 9.8
Week 6
GroupValue95% CI
AVAPS-AE65.0± 4.5
Respironics OmniLab Advanced BiPAP S Mode58.7± 14.7
Respironics OmniLab Advanced CPAP Mode66.2± 5.9
Apnea Hypopnea Index (AHI) Secondary · Screening & 6 weeks

The AHI is the number of apneas and hypopneas per hour of sleep. It will be evaluated during the screening sleep study and the 6 week follow up sleep study. AHI less than 5 is considered normal. For an Apnea-Hypopnea Index (or AHI) from 5 to 15 denotes mild sleep apnea. Fifteen to 30 is moderate, while a greater than 30 AHI is considered severe.

Screening
GroupValue95% CI
AVAPS-AE84.5± 37.9
Respironics OmniLab Advanced BiPAP S Mode67.7± 23.9
Respironics OmniLab Advanced CPAP Mode85.4± 33.5
Titration
GroupValue95% CI
AVAPS-AE16.1± 11.6
Respironics OmniLab Advanced BiPAP S Mode22.4± 11.1
Respironics OmniLab Advanced CPAP Mode30.1± 23.6
Week 6
GroupValue95% CI
AVAPS-AE15.5± 11.8
Respironics OmniLab Advanced BiPAP S Mode12.4± 14.8
Respironics OmniLab Advanced CPAP Mode7.4± 7.9
Epworth Sleepiness Scale Secondary · Screening & 6 weeks

Epworth Sleepiness scale is a measure of daytime sleepiness. It is a series of 8 questions answered on a scale of 0 to 3, 0 being no chance of dozing and 3 being a high chance of dozing. The range of the scale is 0 to 24. The higher the total score, the higher the chance of falling asleep.

Screening
GroupValue95% CI
AVAPS-AE14.9± 4.8
Respironics OmniLab Advanced BiPAP S Mode12.0± 5.2
Respironics OmniLab Advanced CPAP Mode11.5± 6.1
Week 6
GroupValue95% CI
AVAPS-AE9.8± 5.8
Respironics OmniLab Advanced BiPAP S Mode8.1± 6.1
Respironics OmniLab Advanced CPAP Mode5.9± 5.0
Severe Respiratory Insufficiency Questionnaire (SRIQ) Secondary · Screening & 6 weeks

The SRIQ is a 49 question survey. This survey asks questions about the past week. It is answered on a scale of -2 to 2 and converted to 1 to 5, 1 is completely untrue and 5 is always true. The questionnaire is broken down into 7 sections when scoring: respiratory complaints, physical functioning, attendant systems and sleep, social relationships, anxiety, psychological well-being and social functioning. Once each scale score is calculated. The average score can be calculated by taking the mean of the subscales. This process of transformation produces a score between 0 and 100 with higher value

Screening
GroupValue95% CI
AVAPS-AE52.0± 14.5
Respironics OmniLab Advanced BiPAP S Mode53.4± 14.5
Respironics OmniLab Advanced CPAP Mode60.0± 16.1
Week 6
GroupValue95% CI
AVAPS-AE61.0± 13.5
Respironics OmniLab Advanced BiPAP S Mode64.8± 18.4
Respironics OmniLab Advanced CPAP Mode69.7± 13.4
Ventilator Adherence - Average Hours Secondary · 6 weeks

The average number of hours ventilator was used per each day used.

GroupValue95% CI
AVAPS-AE4.8± 0.9
Respironics OmniLab Advanced BiPAP S Mode5.2± 1.7
Respironics OmniLab Advanced CPAP Mode6.6± 0.4
Ventilator Adherence - Days Used Secondary · 6 weeks

Average number of days used per week

GroupValue95% CI
AVAPS-AE5.3± 0.9
Respironics OmniLab Advanced BiPAP S Mode5.3± 1.5
Respironics OmniLab Advanced CPAP Mode6.9± 0.5
Room Air Sp02 Assessment Via Pulse Oximetry Secondary · Screening & 6 weeks

Oxygen saturation measurements as determined by pulse oximetry

Screening
GroupValue95% CI
AVAPS-AE92.5± 3.4
Respironics OmniLab Advanced BiPAP S Mode90.6± 4.1
Respironics OmniLab Advanced CPAP Mode92.9± 2.5
Week 6
GroupValue95% CI
AVAPS-AE94.6± 2.0
Respironics OmniLab Advanced BiPAP S Mode90.1± 7.2
Respironics OmniLab Advanced CPAP Mode94.1± 2.5
Duration, Efficiency and Quality of Sleep and Sleepiness (Derived From Sleep Study) - Duration Secondary · Screening & 6 weeks

Duration, efficiency and quality of sleepiness are measured by a number of different parameters. Total sleep time in each stage provides the average amount of time a participant was in that stage of sleep. This includes Stage 1, Stage 2, Stage 3/4, and Rapid Eye Movement (REM) sleep.

Total Sleep Time Stage 1- Screening
GroupValue95% CI
AVAPS-AE28.4± 19.5
Respironics OmniLab Advanced BiPAP S Mode24.6± 26.6
Respironics OmniLab Advanced CPAP Mode18.9± 15.6
Total Sleep Time Stage 1- 6 weeks
GroupValue95% CI
AVAPS-AE10.0± 6.8
Respironics OmniLab Advanced BiPAP S Mode13.1± 10.3
Respironics OmniLab Advanced CPAP Mode10.1± 7.3
Total Sleep Time Stage 2- Screening
GroupValue95% CI
AVAPS-AE50.8± 15.8
Respironics OmniLab Advanced BiPAP S Mode59.1± 22.4
Respironics OmniLab Advanced CPAP Mode64.8± 15.8
Total Sleep Time Stage 2-6 weeks
GroupValue95% CI
AVAPS-AE59.2± 15.1
Respironics OmniLab Advanced BiPAP S Mode52.4± 14.3
Respironics OmniLab Advanced CPAP Mode53.2± 15.4
Total Sleep Time Stage 3/4 - Screening
GroupValue95% CI
AVAPS-AE8.5± 13.7
Respironics OmniLab Advanced BiPAP S Mode8.1± 11.7
Respironics OmniLab Advanced CPAP Mode7.8± 8.4
Total Sleep Time Stagev3/4-6 weeks
GroupValue95% CI
AVAPS-AE12.5± 13.2
Respironics OmniLab Advanced BiPAP S Mode14.0± 10.9
Respironics OmniLab Advanced CPAP Mode16.6± 15.8
Total Sleep Time Stage REM- Screening
GroupValue95% CI
AVAPS-AE13.5± 7.4
Respironics OmniLab Advanced BiPAP S Mode8.2± 10.1
Respironics OmniLab Advanced CPAP Mode8.5± 5.1
Total Sleep Time Stage REM-6 weeks
GroupValue95% CI
AVAPS-AE18.3± 8.9
Respironics OmniLab Advanced BiPAP S Mode20.4± 9.1
Respironics OmniLab Advanced CPAP Mode20.1± 7.5
Duration and Quality of Sleep and Sleepiness (Derived From Sleep Study) - Sleep Efficiency Secondary · Screening & 6 weeks

Duration, efficiency and quality of sleepiness are measured by a number of different parameters. Sleep efficiency is measured by the total time a participant is spent asleep.

Sleep Efficiency - Screening
GroupValue95% CI
AVAPS-AE74.4± 14.9
Respironics OmniLab Advanced BiPAP S Mode64.5± 14.9
Respironics OmniLab Advanced CPAP Mode74.6± 18.9
Sleep Efficiency - 6 weeks
GroupValue95% CI
AVAPS-AE86.8± 8.4
Respironics OmniLab Advanced BiPAP S Mode71.4± 17.1
Respironics OmniLab Advanced CPAP Mode74.4± 23.8
Duration, Efficiency and Quality of Sleep and Sleepiness (Derived From Sleep Study)- Arousal and Awakening Indices Secondary · Screening & 6 weeks

The arousal index is measured by the average number of arousals or awakenings a participant has over an hour of sleep.

Screening
GroupValue95% CI
AVAPS-AE68.2± 31.2
Respironics OmniLab Advanced BiPAP S Mode66.0± 20.9
Respironics OmniLab Advanced CPAP Mode71.4± 27.1
6 weeks
GroupValue95% CI
AVAPS-AE19.4± 9.3
Respironics OmniLab Advanced BiPAP S Mode23.0± 10.9
Respironics OmniLab Advanced CPAP Mode21.3± 10.1
Duration, Efficiency and Quality of Sleep and Sleepiness (Derived From Sleep Study)- Nocturnal O2 Saturation Secondary · Screening & 6 weeks

Measurement of overnight oxygen saturation as measured by percentage of oxygen saturation (SpO2)

Screening
GroupValue95% CI
AVAPS-AE84.2± 6.0
Respironics OmniLab Advanced BiPAP S Mode81.6± 7.5
Respironics OmniLab Advanced CPAP Mode81.1± 8.5
6 weeks
GroupValue95% CI
AVAPS-AE92.7± 2.5
Respironics OmniLab Advanced BiPAP S Mode93.3± 2.9
Respironics OmniLab Advanced CPAP Mode94.5± 1.4

Adverse events — posted to ClinicalTrials.gov

Time frame: All Adverse Events experienced over 6 weeks were collected.. Reporting threshold: 5%. Adverse-event reports describe events observed during the trial — not all are caused by the drug.

AVAPS-AE
Serious: 0/11 (0%)
Deaths: 0/11
Respironics OmniLab Advanced BiPAP S Mode
Serious: 0/10 (0%)
Deaths: 0/10
Respironics OmniLab Advanced CPAP Mode
Serious: 2/11 (18%)
Deaths: 0/11

Serious adverse events (2 terms)

ReactionSystemAVAPS-AERespironics OmniLab Advanc…Respironics OmniLab Advanc…
Chest PainCardiac disorders
Fournier's GangreneRenal and urinary disorders
Other adverse events (1 terms — click to expand)

ReactionSystemAVAPS-AERespironics OmniLab Advanc…Respironics OmniLab Advanc…
Chest PainCardiac disorders

Most-reported serious reactions: Chest Pain, Fournier's Gangrene.

Data from ClinicalTrials.gov NCT01368614 adverse events section.

Sponsor's own description

The purpose of this study is to evaluate the feasibility of using of the Average Volume Assured Pressure Support (AVAPS-AE) mode versus Continuous Positive Airway Pressure (CPAP) and bilevel pressure support ventilation (PSV) modes of ventilation in patients diagnosed with Obesity Hypoventilation syndrome (OHS). The investigators believe the use of the AVAPS-AE mode of ventilation after 6 weeks will yield daytime gas exchange values which are equivalent or no worse when compared to using CPAP and bilevel PSV modes of ventilation in the OHS population.

Publications & conference data

4 peer-reviewed publications reference this trial (live from Europe PMC):

  1. Exosomal Cargo Properties, Endothelial Function and Treatment of Obesity Hypoventilation Syndrome: A Proof of Concept Study.
    Bhattacharjee R, Khalyfa A, Khalyfa AA, Mokhlesi B, et al · · 2018 · cited 31× · PMID 29734990 · DOI 10.5664/jcsm.7110
  2. Positive airway pressure improves nocturnal beat-to-beat blood pressure surges in obesity hypoventilation syndrome with obstructive sleep apnea.
    Carter JR, Fonkoue IT, Grimaldi D, Emami L, et al · · 2016 · cited 12× · PMID 26818059 · DOI 10.1152/ajpregu.00516.2015
  3. CPAP titration failure is not equivalent to long-term CPAP treatment failure in patients with obesity hypoventilation syndrome: a case series.
    Lastra AC, Masa JF, Mokhlesi B. · · 2020 · cited 3× · PMID 32713421 · DOI 10.5664/jcsm.8712
  4. Deep learning applied to polysomnography to predict blood pressure in obstructive sleep apnea and obesity hypoventilation: a proof-of-concept study.
    Prasad B, Agarwal C, Schonfeld E, Schonfeld D, et al · · 2020 · cited 2× · PMID 32484157 · DOI 10.5664/jcsm.8608

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Primary sources · FDA · ClinicalTrials.gov · EMA · SEC EDGAR · ChEMBL · Wikidata · full sourcing