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

This study has been completed.
Information provided by (Responsible Party):
Carole Marcus, Children's Hospital of Philadelphia Identifier:
First received: January 10, 2013
Last updated: June 18, 2013
Last verified: June 2013
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.

Condition Intervention Phase
Organic Pediatric Obstructive Sleep Apnea
Device: Nasal Expiratory Positive Airway Pressure Device
Device: placebo sham
Early Phase 1

Study Type: Interventional
Study Design: Allocation: Randomized
Intervention Model: Crossover Assignment
Masking: Double Blind (Participant, Care Provider, Investigator)
Primary Purpose: Treatment
Official Title: Nasal Expiratory Positive Airway Pressure for the Treatment of Pediatric Obstructive Sleep Apnea Syndrome

Resource links provided by NLM:

Further study details as provided by Children's Hospital of Philadelphia:

Primary Outcome Measures:
  • Apnea hypopnea index [ Time Frame: Approximately one week ]
    The apnea hypopnea index during polysomnography will be compared between the active device and the placebo nights

Secondary Outcome Measures:
  • Adherence using daily logs [ Time Frame: One month ]
    Adherence with using devices will be determined by daily logs and collecting used devices

Other Outcome Measures:
  • Quality of life [ Time Frame: One Month ]
    The Pediatric Quality of Life (PedsQL) score will be compared at baseline and after one month of device usage

Enrollment: 15
Study Start Date: July 2012
Study Completion Date: April 2013
Primary Completion Date: April 2013 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Nasal Expiratory Positive Airway Pressure Devices
Nasal Expiratory Positive Airway Pressure Device
Device: Nasal Expiratory Positive Airway Pressure Device
assigned to Nasal Expiratory Positive Airway Pressure arm
Sham Comparator: placebo sham
A sham device
Device: placebo sham

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.

Ages Eligible for Study:   5 Years to 16 Years   (Child)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   Yes

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.

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Please refer to this study by its identifier: NCT01768065

United States, Pennsylvania
Children's Hospital of Philadelphia
Philadelphia, Pennsylvania, United States, 19104
Sponsors and Collaborators
Children's Hospital of Philadelphia
Principal Investigator: Carole Marcus Children's Hospital of Philadelphia
  More Information

Publications automatically indexed to this study by Identifier (NCT Number):
Responsible Party: Carole Marcus, Director, Sleep Center, Children's Hospital of Philadelphia Identifier: NCT01768065     History of Changes
Other Study ID Numbers: 12-008691
Study First Received: January 10, 2013
Last Updated: June 18, 2013

Keywords provided by Children's Hospital of Philadelphia:

Additional relevant MeSH terms:
Sleep Apnea Syndromes
Sleep Apnea, Obstructive
Respiration Disorders
Respiratory Tract Diseases
Signs and Symptoms, Respiratory
Signs and Symptoms
Sleep Disorders, Intrinsic
Sleep Wake Disorders
Nervous System Diseases processed this record on May 25, 2017