Obstructive Sleep ApneaNCT02566278
Determination of Upper Airway Collapsibility During Routine CPAP Titration
A study testing Upper airway collapsibility (Pcrit) in people with Obstructive Sleep Apnea, run by University of California, San Diego at 1 site in United States.
Trial summary
The investigators hypothesis is that upper airway collapsibility (Pcrit) in patients with obstructive sleep apnea (OSA) can be measured using equipment found in the clinical sleep laboratory and these Pcrit measurements obtained using clinical sleep laboratory equipment is comparable to those obtained using research… Read more about this study
- Who is it for?
- Ages 18 to 79 years
- Conditions the study is for
- Obstructive Sleep Apnea
- What is being tested?
- Upper airway collapsibility (Pcrit)
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 20 participants
- Where
- 1 siteUnited States
- Study dates
- 20 Oct 2015to 25 Jul 2016
- Phase
- Interventional
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 to 79 years
- All sexes
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- Diagnosis of OSA and stable on CPAP treatment > 3 months
Who cannot join
- Pregnancy
- Currently smoking
- Any respiratory disorder other than OSA or well controlled asthma
- Medications known to affect respiratory function (e.g. opioids, benzodiazepines, etc)
Trial locations and contacts
1 site in 1 country.
United States1 site
University of California, San Diego
San Diego, California, 92093
About this study
The investigators hypothesis is that upper airway collapsibility (Pcrit) in patients with obstructive sleep apnea (OSA) can be measured using equipment found in the clinical sleep laboratory and these Pcrit measurements obtained using clinical sleep laboratory equipment is comparable to those obtained using research equipment. OSA is a common disease characterized by repetitive collapse of the upper airway during sleep, leading to hypoxemia and arousals, and which has important neurocognitive and cardiovascular consequences. The single most important factor in the development of OSA is upper airway collapsibility: those with a more collapsible upper airway tend to have OSA while those with a stiffer upper airway do not. The gold standard treatment for OSA is continuous positive airway pressure (CPAP), which acts by stenting open the collapsible airway. Upper airway collapsibility can be measured during sleep by changing the CPAP level and assessing the change in inspiratory flow through the upper airway. Although technically feasible, these measurements are typically only undertaken in research laboratories with specialized equipment. The purpose of this study is to measure upper airway collapsibility using clinically available (i.e. equipment found in a clinical sleep laboratory) equipment only. If successful, upper airway collapsibility could be routinely measured in clinical practice, which could help inform treatment decisions and help individualize therapy for OSA.
Read the detailed description
OSA is defined by total or partial intermittent collapse of the upper airway, resulting in nocturnal hypoxemia and arousals from sleep. OSA is incredible common and has important cardiovascular (e.g. hypertension, coronary artery disease, stroke, atrial fibrillation) and neurocognitive consequences (e.g. depression, motor vehicle accidents). Thus, OSA results in significant morbidity and mortality and a substantial economic burden. The best studied treatment of OSA is continuous positive airway pressure (CPAP), which effectively stents the upper airway open, however, many patients are not able to tolerate it. Other treatments are available, such as oral appliances or upper airway surgery, however these are much more variable in their effectiveness.
Although other factors are important, the most important factor in OSA pathogenesis is upper airway collapsibility. The upper airway collapsibility can be determined during sleep when patients with OSA are on CPAP. The CPAP level is decreased until flow limitation and finally collapse is achieved. The pressure at which the airway collapses is called the pharyngeal critical closing pressure, or Pcrit. When measured in research laboratories, the Pcrit correlates with OSA severity. Subjects with a high Pcrit (e.g. 5cm of water pressure) typically have severe OSA, while those with a lower Pcrit (e.g. 2cm of water pressure) have mild OSA, and those with a negative Pcrit (e.g. -4cm of water, the airway must be sucked closed to collapse) typically have no disease. The Pcrit may also have important implications for treatment. For example, patients with OSA and a very high Pcrit may require CPAP, however, those with a lower or slightly negative Pcrit might be successfully treated by an oral appliance. Thus, knowledge of the Pcrit might be useful in clinical practice, but it is rarely measured outside of the research lab.
To measure Pcrit, patients sleep with a mask over their nose or nose and mouth, and CPAP is applied using a custom made machine that can rapidly change mask pressures. The idea is that rapid changes in airway pressure produce a clear step change in airflow that will be observed quickly. In contrast, during clinical titrations, the CPAP machines change pressure much more slowly to help promote patient comfort. The goal of this research is to determine whether these slower pressure changes could still be used to gather useful information about upper airway collapsibility.
- Conditions
- Obstructive Sleep Apnea
- Being tested
- Upper airway collapsibility (Pcrit)
- Keywords
- Obstructive Sleep Apnea, Pcrit, Upper airway collapsibility
- Medical subject headings
- Sleep Apnea, Obstructive
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Upper airway collapsibility (Pcrit)Other
To measure passive Pcrit, patients sleep with a mask over their nose or nose and mouth, and CPAP is applied using a custom made machine that can rapidly change mask pressures in research setting. The idea is that rapid changes in airway pressure produce a clear step change in airflow that will be observed quickly. In contrast, during clinical titrations, the CPAP machines change pressure much more slowly to help promote patient comfort. Passive Pcrit will be measured using both research and clinical equipment in the same patients and the Pcrit result using clinical CPAP titration equipment will be compared to the gold standard: Pcrit measurement done through research equipment that changes CPAP pressure rapidly.
| Study group | Role | What they receive |
|---|---|---|
| Obstructive Sleep Apnea | Experimental | Upper airway collapsibility (passive Pcrit) will be measured using both clinically available equipment and research equipment in patients with obstructive sleep apnea (OSA) and stable on treatment of continuous positive airway pressure (CPAP) > 3 months to verify the Pcrit measurement obtained by the clinical equipment. Receives: Other: Upper airway collapsibility (Pcrit) |
What is being measured
The primary outcome is the main question the study is designed to answer.
Passive critical closing pressure (Pcrit)
Upper airway collapsibility, as measured by critical closing pressure (Pcrit), defined as the maximum nasal pressure at which the upper airway occludes.
Measured: Baseline
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted2 Oct 2015 (estimated)
- Study start20 Oct 2015
- Primary completion25 Jul 2016
- Study completion25 Jul 2016
Why it stopped: Data collection has been halted. We are not recruiting any more subjects.
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (5)Papers the sponsor has linked to this study.
- Other trials for Obstructive Sleep ApneaStudies of the same condition, open and under way.
- More trials run by University of California, San DiegoThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Diagnosis
- Allocation
- Not applicable
- Intervention model
- Single group
- Masking
- None (open label)
- Enrolment
- 20 participants (actual)
Sponsor and investigators
- Lead sponsor
- University of California, San Diego
- Sponsor type
- University, hospital or other
- Responsible party
- Principal investigator, Robert L. Owens, University of California, San Diego
- Investigators
- Robert Owens, MD, Principal investigator, University of California, San Diego
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT02566278
- Sponsor's protocol ID
- UCSD151355
- Status last verified
- Jul 2019
- First submitted
- 26 Sep 2015
- Last updated
- 10 Jul 2019
- Results posted
- No
- Data monitoring committee
- No
Publications
Malhotra A, Orr JE, Owens RL. On the cutting edge of obstructive sleep apnoea: where next? Lancet Respir Med. 2015 May;3(5):397-403. doi: 10.1016/S2213-2600(15)00051-X. Epub 2015 Apr 14.
PubMed 25887980Wei T, Erlacher MA, Grossman P, Leitner EB, McGinley BM, Patil SP, Smith PL, Schneider H, Schwartz AR, Kirkness JP. Approach for streamlining measurement of complex physiological phenotypes of upper airway collapsibility. Comput Biol Med. 2013 Jun;43(5):600-6. doi: 10.1016/j.compbiomed.2012.12.006. Epub 2013 Mar 18.
PubMed 23517555Owens RL, Edwards BA, Eckert DJ, Jordan AS, Sands SA, Malhotra A, White DP, Loring SH, Butler JP, Wellman A. An Integrative Model of Physiological Traits Can be Used to Predict Obstructive Sleep Apnea and Response to Non Positive Airway Pressure Therapy. Sleep. 2015 Jun 1;38(6):961-70. doi: 10.5665/sleep.4750.
PubMed 25515107Eckert DJ, White DP, Jordan AS, Malhotra A, Wellman A. Defining phenotypic causes of obstructive sleep apnea. Identification of novel therapeutic targets. Am J Respir Crit Care Med. 2013 Oct 15;188(8):996-1004. doi: 10.1164/rccm.201303-0448OC.
PubMed 23721582Owens RL, Malhotra A, Eckert DJ, White DP, Jordan AS. The influence of end-expiratory lung volume on measurements of pharyngeal collapsibility. J Appl Physiol (1985). 2010 Feb;108(2):445-51. doi: 10.1152/japplphysiol.00755.2009. Epub 2009 Nov 25.
PubMed 19940097
Study at a glance
From the registry record, last updated by the sponsor on 10 Jul 2019. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Determination of Upper Airway Collapsibility During Routine CPAP Titration
- ClinicalTrials.gov ID
- NCT02566278
- Acronym / sponsor ID
- UCSD151355
- Conditions
- Obstructive Sleep Apnea
- Keywords
- Obstructive Sleep Apnea, Pcrit, Upper airway collapsibility
- Study type
- Interventional
- Recruitment status
- TerminatedReason stopped: Data collection has been halted. We are not recruiting any more subjects.
- Enrolment
- 20 participants (actual)
- Lead sponsor
- University of California, San DiegoUniversity, hospital or other
- Study start
- 20 Oct 2015 (actual)
- Primary completion
- 25 Jul 2016 (actual)
- Study completion
- 25 Jul 2016 (actual)
- First posted
- 2 Oct 2015 (estimated)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
The investigators hypothesis is that upper airway collapsibility (Pcrit) in patients with obstructive sleep apnea (OSA) can be measured using equipment found in the clinical sleep laboratory and these Pcrit measurements obtained using clinical sleep laboratory equipment is comparable to those obtained using research equipment. OSA is a common disease characterized by repetitive collapse of the upper airway during sleep, leading to hypoxemia and arousals, and which has important neurocognitive and cardiovascular consequences. The single most important factor in the development of OSA is upper airway collapsibility: those with a more collapsible upper airway tend to have OSA while those with a stiffer upper airway do not. The gold standard treatment for OSA is continuous positive airway pressure (CPAP), which acts by stenting open the collapsible airway. Upper airway collapsibility can be measured during sleep by changing the CPAP level and assessing the change in inspiratory flow through the upper airway. Although technically feasible, these measurements are typically only undertaken in research laboratories with specialized equipment. The purpose of this study is to measure upper airway collapsibility using clinically available (i.e. equipment found in a clinical sleep laboratory) equipment only. If successful, upper airway collapsibility could be routinely measured in clinical practice, which could help inform treatment decisions and help individualize therapy for OSA.
Detailed description
OSA is defined by total or partial intermittent collapse of the upper airway, resulting in nocturnal hypoxemia and arousals from sleep. OSA is incredible common and has important cardiovascular (e.g. hypertension, coronary artery disease, stroke, atrial fibrillation) and neurocognitive consequences (e.g. depression, motor vehicle accidents). Thus, OSA results in significant morbidity and mortality and a substantial economic burden. The best studied treatment of OSA is continuous positive airway pressure (CPAP), which effectively stents the upper airway open, however, many patients are not able to tolerate it. Other treatments are available, such as oral appliances or upper airway surgery, however these are much more variable in their effectiveness.
Although other factors are important, the most important factor in OSA pathogenesis is upper airway collapsibility. The upper airway collapsibility can be determined during sleep when patients with OSA are on CPAP. The CPAP level is decreased until flow limitation and finally collapse is achieved. The pressure at which the airway collapses is called the pharyngeal critical closing pressure, or Pcrit. When measured in research laboratories, the Pcrit correlates with OSA severity. Subjects with a high Pcrit (e.g. 5cm of water pressure) typically have severe OSA, while those with a lower Pcrit (e.g. 2cm of water pressure) have mild OSA, and those with a negative Pcrit (e.g. -4cm of water, the airway must be sucked closed to collapse) typically have no disease. The Pcrit may also have important implications for treatment. For example, patients with OSA and a very high Pcrit may require CPAP, however, those with a lower or slightly negative Pcrit might be successfully treated by an oral appliance. Thus, knowledge of the Pcrit might be useful in clinical practice, but it is rarely measured outside of the research lab.
To measure Pcrit, patients sleep with a mask over their nose or nose and mouth, and CPAP is applied using a custom made machine that can rapidly change mask pressures. The idea is that rapid changes in airway pressure produce a clear step change in airflow that will be observed quickly. In contrast, during clinical titrations, the CPAP machines change pressure much more slowly to help promote patient comfort. The goal of this research is to determine whether these slower pressure changes could still be used to gather useful information about upper airway collapsibility.
Study design
- Primary purpose
- Diagnosis
- Allocation
- Not applicable
- Intervention model
- Single group
- Masking
- None (open label)
- Number of arms
- 1
| Arm | Type | Receives |
|---|---|---|
| Obstructive Sleep Apnea | Experimental | Other: Upper airway collapsibility (Pcrit)Upper airway collapsibility (passive Pcrit) will be measured using both clinically available equipment and research equipment in patients with obstructive sleep apnea (OSA) and stable on treatment of continuous positive airway pressure (CPAP) > 3 months to verify the Pcrit measurement obtained by the clinical equipment. |
Who may qualify
- Ages
- 18 to 79 years
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (1 listed)
- Diagnosis of OSA and stable on CPAP treatment > 3 months
Key exclusion criteria (4 listed)
- Pregnancy
- Currently smoking
- Any respiratory disorder other than OSA or well controlled asthma
- Medications known to affect respiratory function (e.g. opioids, benzodiazepines, etc)
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Upper airway collapsibility (Pcrit)To measure passive Pcrit, patients sleep with a mask over their nose or nose and mouth, and CPAP is applied using a custom made machine that can rapidly change mask pressures in research setting. The idea is that rapid changes in airway pressure produce a clear step change in airflow that will be observed quickly. In contrast, during clinical titrations, the CPAP machines change pressure much more slowly to help promote patient comfort. Passive Pcrit will be measured using both research and clinical equipment in the same patients and the Pcrit result using clinical CPAP titration equipment will be compared to the gold standard: Pcrit measurement done through research equipment that changes CPAP pressure rapidly. | Other | Obstructive Sleep Apnea |
Primary outcome
Passive critical closing pressure (Pcrit)
Time frame: Baseline
Upper airway collapsibility, as measured by critical closing pressure (Pcrit), defined as the maximum nasal pressure at which the upper airway occludes.
Results and safety
The study was stopped early (reason given: Data collection has been halted. We are not recruiting any more subjects.). Results are not available in the source record.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 10 Jul 2019.
- Background: PubMed 25887980Malhotra A, Orr JE, Owens RL. On the cutting edge of obstructive sleep apnoea: where next? Lancet Respir Med. 2015 May;3(5):397-403. doi: 10.1016/S2213-2600(15)00051-X. Epub 2015 Apr 14.
- Background: PubMed 23517555Wei T, Erlacher MA, Grossman P, Leitner EB, McGinley BM, Patil SP, Smith PL, Schneider H, Schwartz AR, Kirkness JP. Approach for streamlining measurement of complex physiological phenotypes of upper airway collapsibility. Comput Biol Med. 2013 Jun;43(5):600-6. doi: 10.1016/j.compbiomed.2012.12.006. Epub 2013 Mar 18.
- Background: PubMed 25515107Owens RL, Edwards BA, Eckert DJ, Jordan AS, Sands SA, Malhotra A, White DP, Loring SH, Butler JP, Wellman A. An Integrative Model of Physiological Traits Can be Used to Predict Obstructive Sleep Apnea and Response to Non Positive Airway Pressure Therapy. Sleep. 2015 Jun 1;38(6):961-70. doi: 10.5665/sleep.4750.
- Background: PubMed 23721582Eckert DJ, White DP, Jordan AS, Malhotra A, Wellman A. Defining phenotypic causes of obstructive sleep apnea. Identification of novel therapeutic targets. Am J Respir Crit Care Med. 2013 Oct 15;188(8):996-1004. doi: 10.1164/rccm.201303-0448OC.
- Background: PubMed 19940097Owens RL, Malhotra A, Eckert DJ, White DP, Jordan AS. The influence of end-expiratory lung volume on measurements of pharyngeal collapsibility. J Appl Physiol (1985). 2010 Feb;108(2):445-51. doi: 10.1152/japplphysiol.00755.2009. Epub 2009 Nov 25.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Robert Owens, MD principal investigator
University of California, San Diego
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Upper airway collapsibility (Pcrit) in people with Obstructive Sleep Apnea, run by University of California, San Diego at 1 site in United States.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 1 inclusion and 4 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: stopped early, as of the sponsor's last update on 10 Jul 2019. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
The study was stopped early (reason given: Data collection has been halted. We are not recruiting any more subjects.). Results are not available in the source record.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Passive critical closing pressure (Pcrit) (time frame: Baseline). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT02566278, which also lists 5 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 10 Jul 2019.