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Nasal Expiratory Positive Airway Pressure for the Treatment of Pediatric Obstructive Sleep Apnea Syndrome

Primary Purpose

Organic Pediatric Obstructive Sleep Apnea

Status
Completed
Phase
Early Phase 1
Locations
United States
Study Type
Interventional
Intervention
Nasal Expiratory Positive Airway Pressure Device
placebo sham
Sponsored by
Children's Hospital of Philadelphia
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Organic Pediatric Obstructive Sleep Apnea focused on measuring NEPAP, CPAP, alternative, OSAS

Eligibility Criteria

5 Years - 16 Years (Child)All SexesAccepts Healthy Volunteers

Inclusion Criteria:

  1. Subjects age 5-16 years (note: Due to the size of the devices, it is expected that most children will be at least 8 years old, but a few may be younger. Subjects will be evaluated in clinic to fit for size and habituate to the device)
  2. OSAS (AHI > 5/hr)
  3. Subject has had adenotonsillectomy or is not a candidate for adenotonsillectomy
  4. Subject is non-adherent to CPAP or is seeking an alternative therapy
  5. Tolerance of NEPAP device during a daytime session
  6. Parental/guardian permission (informed consent) and if appropriate, child assent.

Exclusion Criteria:

  1. Severe developmental delay thought to involve a high risk of aspiration
  2. Family does not understand English well enough to perform the standardized, validated questionnaires.
  3. Age >16 years since results may be similar to adult studies in these older patients.
  4. Severe breathing disorder (including respiratory muscle weakness, bullous lung disease, bypassed upper airway, pneumothorax, pneumomediastinum)
  5. Severe heart disease (including heart failure)
  6. An acute upper respiratory (including nasal, sinus or middle ear) inflammation or infection or perforation of the ear drum

Subjects that do not meet all of the enrollment criteria will not be enrolled. Any violations of these criteria will be reported in accordance with Institutional Review Board (IRB) Policies and Procedures.

Study members will not recruit females who are known to be pregnant. However, if a subject becomes pregnant during the study, we will continue to use the device. Pregnancy is not an exclusion criterion as positive airway pressure therapy does not harm the pregnant woman or fetus.

Sites / Locations

  • Children's Hospital of Philadelphia

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Sham Comparator

Arm Label

Nasal Expiratory Positive Airway Pressure Devices

placebo sham

Arm Description

Nasal Expiratory Positive Airway Pressure Device

A sham device

Outcomes

Primary Outcome Measures

Apnea hypopnea index
The apnea hypopnea index during polysomnography will be compared between the active device and the placebo nights

Secondary Outcome Measures

Adherence using daily logs
Adherence with using devices will be determined by daily logs and collecting used devices

Full Information

First Posted
January 10, 2013
Last Updated
September 6, 2019
Sponsor
Children's Hospital of Philadelphia
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1. Study Identification

Unique Protocol Identification Number
NCT01768065
Brief Title
Nasal Expiratory Positive Airway Pressure for the Treatment of Pediatric Obstructive Sleep Apnea Syndrome
Official Title
Nasal Expiratory Positive Airway Pressure for the Treatment of Pediatric Obstructive Sleep Apnea Syndrome
Study Type
Interventional

2. Study Status

Record Verification Date
September 2019
Overall Recruitment Status
Completed
Study Start Date
July 2012 (undefined)
Primary Completion Date
April 2013 (Actual)
Study Completion Date
April 2013 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Children's Hospital of Philadelphia

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
This study will evaluate effectiveness and adherence of the nasal expiratory positive airway pressure (NEPAP) device as an an alternate therapy for children with Obstructive Sleep Apnea Syndrome (OSAS). NEPAP is currently approved for use only in adults.
Detailed Description
The nasal expiratory positive airway pressure (NEPAP) device has been used to treat OSAS in adults. A disposable device is placed in each nostril at night and attached with adhesive. The device acts as a one-way valve, during inspiration the valve opens, with negligible resistance to flow. During expiration, the valve closes and airflow is directed through small air channels, increasing resistance. The increased resistance helps to maintain the upper airway pressure during the critical end-expiratory period when the upper airway has been found to be most narrow in the breaths preceding an apnea event. In contrast to Continuous Positive Airway Pressure (CPAP) which provides positive pressure during both inspiration and expiration, NEPAP creates pressure during expiration. NEPAP is a potential alternative therapy which is less cumbersome than CPAP and may increase adherence.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Organic Pediatric Obstructive Sleep Apnea
Keywords
NEPAP, CPAP, alternative, OSAS

7. Study Design

Primary Purpose
Treatment
Study Phase
Early Phase 1
Interventional Study Model
Crossover Assignment
Masking
ParticipantCare ProviderInvestigator
Allocation
Randomized
Enrollment
15 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Nasal Expiratory Positive Airway Pressure Devices
Arm Type
Experimental
Arm Description
Nasal Expiratory Positive Airway Pressure Device
Arm Title
placebo sham
Arm Type
Sham Comparator
Arm Description
A sham device
Intervention Type
Device
Intervention Name(s)
Nasal Expiratory Positive Airway Pressure Device
Intervention Description
assigned to Nasal Expiratory Positive Airway Pressure arm
Intervention Type
Device
Intervention Name(s)
placebo sham
Primary Outcome Measure Information:
Title
Apnea hypopnea index
Description
The apnea hypopnea index during polysomnography will be compared between the active device and the placebo nights
Time Frame
Approximately one week
Secondary Outcome Measure Information:
Title
Adherence using daily logs
Description
Adherence with using devices will be determined by daily logs and collecting used devices
Time Frame
One month
Other Pre-specified Outcome Measures:
Title
Quality of life
Description
The Pediatric Quality of Life (PedsQL) score will be compared at baseline and after one month of device usage
Time Frame
One Month

10. Eligibility

Sex
All
Minimum Age & Unit of Time
5 Years
Maximum Age & Unit of Time
16 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion Criteria: Subjects age 5-16 years (note: Due to the size of the devices, it is expected that most children will be at least 8 years old, but a few may be younger. Subjects will be evaluated in clinic to fit for size and habituate to the device) OSAS (AHI > 5/hr) Subject has had adenotonsillectomy or is not a candidate for adenotonsillectomy Subject is non-adherent to CPAP or is seeking an alternative therapy Tolerance of NEPAP device during a daytime session Parental/guardian permission (informed consent) and if appropriate, child assent. Exclusion Criteria: Severe developmental delay thought to involve a high risk of aspiration Family does not understand English well enough to perform the standardized, validated questionnaires. Age >16 years since results may be similar to adult studies in these older patients. Severe breathing disorder (including respiratory muscle weakness, bullous lung disease, bypassed upper airway, pneumothorax, pneumomediastinum) Severe heart disease (including heart failure) An acute upper respiratory (including nasal, sinus or middle ear) inflammation or infection or perforation of the ear drum Subjects that do not meet all of the enrollment criteria will not be enrolled. Any violations of these criteria will be reported in accordance with Institutional Review Board (IRB) Policies and Procedures. Study members will not recruit females who are known to be pregnant. However, if a subject becomes pregnant during the study, we will continue to use the device. Pregnancy is not an exclusion criterion as positive airway pressure therapy does not harm the pregnant woman or fetus.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Carole Marcus
Organizational Affiliation
Children's Hospital of Philadelphia
Official's Role
Principal Investigator
Facility Information:
Facility Name
Children's Hospital of Philadelphia
City
Philadelphia
State/Province
Pennsylvania
ZIP/Postal Code
19104
Country
United States

12. IPD Sharing Statement

Citations:
PubMed Identifier
24932147
Citation
Kureshi SA, Gallagher PR, McDonough JM, Cornaglia MA, Maggs J, Samuel J, Traylor J, Marcus CL. Pilot study of nasal expiratory positive airway pressure devices for the treatment of childhood obstructive sleep apnea syndrome. J Clin Sleep Med. 2014 Jun 15;10(6):663-9. doi: 10.5664/jcsm.3796.
Results Reference
derived

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Nasal Expiratory Positive Airway Pressure for the Treatment of Pediatric Obstructive Sleep Apnea Syndrome

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