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Obstructive Sleep Apnea of AdultNCT06277115

Acute and Long-term Effects of CPAP in OSA

A study testing Continuous positive airway pressure (CPAP) in people with Obstructive Sleep Apnea of Adult, run by University of Zurich at 1 site in Switzerland.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

Two-phase interventional non-inferiority trial (phase 1: at least 8 weeks of CPAP; phase 2: 2 weeks of CPAP withdrawal) including 32 patients with moderate to severe OSA to compare the physiological consequences of a short-term CPAP withdrawal to the changes in previously untreated OSA. Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Obstructive Sleep Apnea of Adult
What is being tested?
Continuous positive airway pressure (CPAP)
Type of treatment
Medical device
Could I receive a placebo?
No, everyone receives an active treatment
How many people
36 participants
Where
1 siteSwitzerland
Study dates
1 Feb 2021to 1 Jul 2024
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 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Age ≥ 18 years
  • Untreated moderate or severe OSA with an apnoea-hypopnoea-index (AHI) of ≥ 20/h and an oxygen desaturation index (>3%-dips) of ≥ 20/h in an in-laboratory sleep study
  • Epworth Sleepiness Scale Score ≥7/24 points
  • Indication for CPAP therapy
  • Written informed consent

Who cannot join

  • Moderate or more severe obstructive or restrictive ventilatory disorder (FEV1 or FVC < 70%)
  • Heart failure
  • Other types of sleep-related breathing disorders, e.g. sleep-associated hypoventilation, central sleep apnoea, Cheyne Stoke's Breathing
  • Hypoxic or hypercapnic respiratory failure (awake paO2 < 9 kPa or paCO2 > 6 kPa)
  • Active treatment for OSA (CPAP, mandibular advancement device, hypoglossal nerve stimulation)
  • Current professional driver or previous sleepiness-related accidents
  • Pregnancy

Trial locations and contacts

1 site in 1 country.

Switzerland1 site
  • University Hospital Zurich

    Zurich, 8091

Other trials in Switzerland

About this study

Official title: Acute, Intermediate and Long-term Effects of CPAP Therapy in Obstructive Sleep Apnoea: a Two-phase Interventional Trial.

Two-phase interventional non-inferiority trial (phase 1: at least 8 weeks of CPAP; phase 2: 2 weeks of CPAP withdrawal) including 32 patients with moderate to severe OSA to compare the physiological consequences of a short-term CPAP withdrawal to the changes in previously untreated OSA. The trial has been designed as a validation of the CPAP-withdrawal model. Baseline in-laboratory sleep studies will be performed prior to CPAP initiation, after 6-8 weeks on CPAP (treatment effect) and following 2 weeks of CPAP therapy withdrawal (withdrawal effect, effect of OSA recurrence).

Read the detailed description

Background and Aim: Obstructive sleep apnoea (OSA) is a prevalent sleep-related breathing disorder. OSA is associated with daytime sleepiness, impaired quality of life, and adverse cardiovascular outcome. OSA can be effectively treated with nocturnal continuous positive airway pressure (CPAP) that restores normal breathing during sleep by preventing upper airway collapse. However, many patients in whom treatment of OSA is indicated are not able to adhere to CPAP, and the consequences of untreated OSA seem to differ between OSA phenotypes. Therefore, treatment alternatives to CPAP and a better understanding of treatment implications in different phenotypes of OSA are important targets in this research field. Thus, effective and controlled study designs are needed to address these research questions. Conventional randomised controlled CPAP trials are limited by low CPAP adherence resulting in an underestimation of the treatment effect. In addition, the impracticability of withholding an effective treatment from symptomatic patients resulting in inclusion of less symptomatic and patients with less severe OSA has limited the conclusions from previous trials. The CPAP therapy withdrawal model was introduced to allow studying the pathophysiological consequences of OSA and treatment effects of CPAP in an effective and controlled way. Optimally treated patients previously diagnosed with OSA established on CPAP therapy are included and undergo a short-term therapy interruption. A therapy withdrawal results in recurrence of OSA and pathophysiological changes can be attributed to OSA in this controlled model. However, it is uncertain whether the consequences of OSA during a short-term CPAP therapy withdrawal are comparable to long-term consequences of untreated OSA.

The aim of this two-phase interventional trial is to assess the effects of intermediate and long-term CPAP therapy as well as acute CPAP therapy withdrawal resulting in OSA recurrence compared to longstanding untreated OSA on cardiovascular and symptom outcomes in moderate and severe OSA. The objective is to study the comparability of conventional CPAP therapy trials with the CPAP withdrawal model in terms of evaluating relevant cardiovascular and patient-centred outcomes in OSA.

The investigators hypothesise that the treatment effect of CPAP in previously treatment-naïve patients with OSA - if adherent to CPAP - will support the same conclusions on OSA pathophysiology and therapy effects as a short-term CPAP withdrawal in treatment-adherent patients having a recurrence of OSA in response to CPAP withdrawal and thus support the use of this effective CPAP withdrawal model to use as future study design in interventional trials in OSA. It is hypothesised that the CPAP withdrawal is non-inferior to conventional CPAP trials in studying the effect on blood pressure and OSA-symptoms.

Being tested
Continuous positive airway pressure (CPAP)

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Continuous positive airway pressure (CPAP)Device

    Nocturnal continuous positive airway pressure therapy is the gold standard treatment for symptomatic OSA. It provides positive pressure via a nasal or oronasal mask to prevent upper airway collapse during sleep.

Study groups in NCT06277115
Study groupRoleWhat they receive
Single arm (therapy initiation followed by therapy withdrawal)OtherContinuous positive airway pressure (CPAP)
Receives: Device: Continuous positive airway pressure (CPAP)

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Nocturnal systolic blood pressure

    Ambulatory blood pressure monitoring (ABPM)

    Measured: at baseline and at 2 and at least 8 weeks of CPAP as well as after 1 and after 2 weeks of CPAP withdrawal

  2. Epworth Sleepines Scale Score (ESS)

    Subjective sleepiness, ESS min-max 0-24 points and ESS >10 indicating pathological daytime sleepiness

    Measured: at baseline and at 2 and at least 8 weeks of CPAP as well as after 1 and after 2 weeks of CPAP withdrawal

Secondary outcomes (20)
  1. 48h, 24h, diurnal and nocturnal systolic and diastolic blood pressure

    ABPM

    Measured: at baseline and at 2 and at least 8 weeks of CPAP as well as after 1 and after 2 weeks of CPAP withdrawal

  2. Office systolic and diastolic blood pressure

    Morning office blood pressure

    Measured: at baseline and at 2 and at least 8 weeks of CPAP as well as after 1 and after 2 weeks of CPAP withdrawal

  3. 48h, 24h, diurnal, nocturnal and office heart rate

    Heart rate from ABPM, office measurement and from sleep studies

    Measured: at baseline and at 2 and at least 8 weeks of CPAP as well as after 1 and after 2 weeks of CPAP withdrawal

  4. Heart rate variability in the time and frequency domain (CV, RMSSD, pRR50, LF, HF, LF/HF)

    Measures of heart rate variability (daytime and nighttime)

    Measured: at baseline and at 2 and at least 8 weeks of CPAP as well as after 1 and after 2 weeks of CPAP withdrawal

  5. Blood pressure variability (BPV, systolic and diastolic)

    BPV from ABPM and beat-to-beat blood pressure measurement

    Measured: at baseline and at 2 and at least 8 weeks of CPAP as well as after 1 and after 2 weeks of CPAP withdrawal

  6. Baroreflex sensitivity (BRS)

    Finometer

    Measured: at baseline and at 2 and at least 8 weeks of CPAP as well as after 1 and after 2 weeks of CPAP withdrawal

  7. Arterial stiffness

    ABPM

    Measured: at baseline and at 2 and at least 8 weeks of CPAP as well as after 1 and after 2 weeks of CPAP withdrawal

  8. Measures of nocturnal hypoventilation (median and maximal transcutaneous partial pressure of CO2 = tcpCO2)

    Sleep study parameters

    Measured: at baseline and at least 8 weeks of CPAP as well as after 2 weeks of CPAP withdrawal

  9. Measures of nocturnal hypoxaemia (mean nocturnal oxygen saturation = ¢SpO2)

    Sleep study parameters

    Measured: at baseline and at least 8 weeks of CPAP as well as after 2 weeks of CPAP withdrawal

  10. Measures of nocturnal hypoxaemia (time spent with SpO2 below 90% = t<90)

    Sleep study parameters

    Measured: at baseline and at least 8 weeks of CPAP as well as after 2 weeks of CPAP withdrawal

  11. Measures of nocturnal hypoxaemia (hypoxic burden)

    Sleep study parameters

    Measured: at baseline and at least 8 weeks of CPAP as well as after 2 weeks of CPAP withdrawal

  12. Measures of OSA severity (apnoea-hypopnoea-index)

    Sleep study parameters

    Measured: at baseline and at least 8 weeks of CPAP as well as after 2 weeks of CPAP withdrawal

  13. Measures of OSA severity (oxygen-desaturation index)

    Sleep study parameters

    Measured: at baseline and at least 8 weeks of CPAP as well as after 2 weeks of CPAP withdrawal

  14. Sleepiness (Stanford Sleepiness Scale (SSS))

    Questionnaire; 7-point Likert scale to quantify a patient's sleepiness at the time the questionnaire is completed; highr scores indicate more sleepiness

    Measured: at baseline and at 2 and at least 8 weeks of CPAP as well as after 1 and after 2 weeks of CPAP withdrawal

  15. Fatigue (fatigue severity scale (FSS))

    Questionnaire; 9 items, higher score indicates more fatigue

    Measured: at baseline and at 2 and at least 8 weeks of CPAP as well as after 1 and after 2 weeks of CPAP withdrawal

  16. Disease-specific quality of life (Functional Outcomes of Sleep Questionnaire (FOSQ))

    Questionnaires, Disease-specific quality of life questionnaire to determine functional status in adults; measures are designed to assess the impact of disorders of excessive sleepiness on multiple activities of everyday living and the extent to which these abilities are improved by effective treatment; 30 items; higher scores are better

    Measured: at baseline and at 2 and at least 8 weeks of CPAP as well as after 1 and after 2 weeks of CPAP withdrawal

  17. Superoxide dismutase

    Marker of oxidative stress (U/ml)

    Measured: at baseline and at 2 and at least 8 weeks of CPAP as well as after 1 and after 2 weeks of CPAP withdrawal

  18. Urinary catecholamines

    Epinephrine and norepinephrine in morning urine (nnmol/mmol)

    Measured: at baseline and at 2 and at least 8 weeks of CPAP as well as after 1 and after 2 weeks of CPAP withdrawal

  19. Pulse rise index (>6 beats per minute)

    from nocturnal oximetry

    Measured: at baseline and at 2 and at least 8 weeks of CPAP as well as after 1 and after 2 weeks of CPAP withdrawal

  20. Nocturnal oxymetry measures (¢SpO2, t<90, ODI-3%, ODI-4%)

    nocturnal pulse oximetry

    Measured: at baseline and at 2 and at least 8 weeks of CPAP as well as after 1 and after 2 weeks of CPAP withdrawal

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted26 Feb 2024
  2. Study start1 Feb 2021
  3. Primary completion1 Jul 2024
  4. Study completion1 Jul 2024

Resources

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
Treatment
Allocation
Not applicable
Intervention model
Single group
Model description
Two-phase intervention: several weeks of CPAP therapy followed by two weeks CPAP therapy withdrawal
Masking
None (open label)
Enrolment
36 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT06277115
Sponsor's protocol ID
BASEC Nr. 2020-02002
Status last verified
Dec 2024
First submitted
10 Feb 2024
Last updated
4 Dec 2024
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No

Questions about this trial

What is this clinical trial studying?

A study testing Continuous positive airway pressure (CPAP) in people with Obstructive Sleep Apnea of Adult, run by University of Zurich at 1 site in Switzerland.

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 5 inclusion and 7 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: finished, as of the sponsor's last update on 4 Dec 2024. 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 Switzerland. 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 is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

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?

Nocturnal systolic blood pressure (time frame: at baseline and at 2 and at least 8 weeks of CPAP as well as after 1 and after 2 weeks of CPAP withdrawal). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?
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 4 Dec 2024.

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