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Trial registered on ANZCTR
Registration number
ACTRN12612000794808
Ethics application status
Approved
Date submitted
17/05/2012
Date registered
27/07/2012
Date last updated
19/07/2018
Type of registration
Retrospectively registered
Titles & IDs
Public title
Does changing the continuous positive airways pressure (CPAP) interface alter pressure requirements in patients with obstructive sleep apnoea
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Scientific title
Does changing the continuous positive airways pressure (CPAP) interface alter pressure requirements in patients with obstructive sleep apnoea?
Nasal versus full face. Same pressure?
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Secondary ID [1]
279788
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Nil
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Universal Trial Number (UTN)
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Trial acronym
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Obstructive sleep apnea
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Condition category
Condition code
Respiratory
285847
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0
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Sleep apnoea
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
Patients will be assigned to using an auto-titrating positive airways pressure (APAP) device overnight for 2 weeks using a nasal interface and two weeks using a full face interface. The nasal interface covers the nose only. The full face interface covers the nose and mouth. A full face interface may be used if a patient is unable to keep their mouth shut resulting in a pressure leak from the mouth. This therapy applies positive airways pressure to the upper airway and leaks result in a loss of effective pressure. As the full face mask sits lower on the face, it is postulated that adjusting the interface to seal the mask will apply pressure to the lower jaw. This may cause the jaw to be pulled back towards the airway causing the airway to narrow and thus a higher pressure may be required to maintain airway patency. The nasal interface sits above the top lip and any adjustment of this interface does not cause the jaw to move.
The first interface will be assigned in random order. This is a crossover study and there is no washout period between treatments.
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Intervention code [1]
284107
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Treatment: Devices
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Comparator / control treatment
Patients will be assigned to using an auto-titrating positive airways pressure device overnight for 2 weeks using a nasal interface and two weeks using a full face interface. The first interface will be assigned in random order. This is a crossover study and there is no washout period between treatments. The nasal interface will be deemed to be the control in this study.
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Control group
Active
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Outcomes
Primary outcome [1]
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The primary outcome measure is required therapeutic pressure. This will be acquired from the downloaded data from the auto-titrating device which calculates the 95th centile pressure using a programmed algorithm.
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Assessment method [1]
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Timepoint [1]
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Required therapeutic pressure is measured after 2 weeks of each interface use.
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Secondary outcome [1]
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Patient's preference. This will be assessed by asking the patient which interface they prefer. They will also be given a Visual Analogue Scale at the end of each two week period to assess:
1) how comfortable was the mask
2) how well did it seal
3) how easy was it to use
They will also be asked to make any other comment about the mask.
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Assessment method [1]
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Timepoint [1]
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Patient's preference enquired after completion of study.
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Eligibility
Key inclusion criteria
Patients who have been diagnosed with obstructive sleep apnoea and who are currently using CPAP therapy and are able to tolerate both a nasal interface and a full face interface.
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Minimum age
18
Years
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Maximum age
No limit
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Sex
Both males and females
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Can healthy volunteers participate?
No
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Key exclusion criteria
Pregnant women
Intellectually or mentally impaired patients
Patients highly dependant on medical care
Patients currently experiencing other problems with CPAP that affect their use of therapy
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Study design
Purpose of the study
Treatment
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Allocation to intervention
Randomised controlled trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
Patients who are seen in the Sleep Disorders Centre who are on CPAP therapy and are able to tolerate both a nasal interface and a full face interface will be asked to participate. Patients will have the study explained to them and given a Participant Information Sheet. If agreeable, they will then be asked to sign the Consent Form which will be kept in the Sleep Disorders Centre. Patients will be assigned to undergo two weeks treatment using a nasal interface and two weeks using a full face interface in random order. Allocation is not concealed.
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
Simple randomisation by using a randomisation table created by computer software.
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Masking / blinding
Open (masking not used)
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Who is / are masked / blinded?
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Intervention assignment
Crossover
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Other design features
Random order crossover design.
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Phase
Not Applicable
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Type of endpoint/s
Efficacy
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Statistical methods / analysis
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Recruitment
Recruitment status
Completed
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Date of first participant enrolment
Anticipated
16/02/2010
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Actual
16/02/2010
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Date of last participant enrolment
Anticipated
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Actual
7/03/2017
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Date of last data collection
Anticipated
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Actual
4/04/2017
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Sample size
Target
56
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Accrual to date
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Final
60
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Recruitment in Australia
Recruitment state(s)
QLD
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Funding & Sponsors
Funding source category [1]
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Self funded/Unfunded
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Name [1]
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Address [1]
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Country [1]
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Australia
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Primary sponsor type
Hospital
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Name
The Princess Alexandra Hospital
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Address
199 Ipswich Road
Woolloongabba
Queensland
4102
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Country
Australia
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Secondary sponsor category [1]
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None
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Name [1]
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Address [1]
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Country [1]
284043
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Ethics approval
Ethics application status
Approved
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Ethics committee name [1]
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Princess Alexandra Hospital Human Research Ethics Committee
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Ethics committee address [1]
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Human Research Ethics Committee Centres for Health Research Princess Alexandra Hospital 199 Ipswich Road Woolloongabba Queensland 4102
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Ethics committee country [1]
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Australia
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Date submitted for ethics approval [1]
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Approval date [1]
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25/11/2009
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Ethics approval number [1]
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HREC/09/QPAH/244
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Summary
Brief summary
Continuous positive airways pressure (CPAP) is the treatment of choice for patients who have obstructive sleep apnoea (OSA). The patient wears an interface attached to a pump which delivers pressurized air to the upper airway, thereby splinting the airway open. The interface is usually one of three types, nasal pillows which sit directly in the nostrils, a nasal mask which covers the nose or a full-face mask which covers the nose and mouth. The nasal pillows and nasal mask require the patient to keep their mouth closed during treatment as opening the mouth releases pressure and this mouth leak results in less air pressure in the upper airway where it is required to splint the airway. The full-face mask ensures the nose and mouth are both in the pressurised area and thus prevents mouth leak from being a problem. Although the difference in dead space between the interfaces has been examined, the effect of the mechanical pressure from the headgear on the position of the lower jaw which is required to seal the full-face mask has not been clearly assessed. The force applied to the headgear to seal the full-face mask may result in the lower jaw being pushed back and thus the diameter of the upper airway being reduced. If this occurs, a higher CPAP pressure would be required to splint the airway. An alternative treatment for OSA is the mandibular advancement splint which relies on a dental device to pull the jaw forward to enlarge the airway opening. It is not unreasonable to presume that pressure in the reverse direction would have the opposite effect. This study aims to assess the pressure requirements of nasal versus full-face mask in patients with OSA by using auto-titrating continuous positive airways pressure (APAP).The APAP devices sense flow limitation and snore and respond to these by increasing or decreasing the positive airways pressure as required. The downloaded data can be examined to assess the pressure requirements of the patient. Patients will be assessed in a random order, crossover study comprising a two week period each of a suitably fitted nasal interface and a suitably fitted full-face interface. As the data will be collected over a two week period, night to night variation should be minimised. The APAP will assess the pressure requirements for each period to examine if there is any difference in pressure requirements between the two interfaces. The Mallampati score and pharyngeal dimensions will also be evaluated to examine if this is a possible pre-disposing factor.
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Trial website
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Trial related presentations / publications
22nd Annual Scientific Meeting of the Australasian Sleep Association and Australasian Sleep Technologists Association, Christchurch, New Zealand, 21-23 October 2010: Poster presentation with oral component.
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Public notes
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Contacts
Principal investigator
Name
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Mrs Teresa Shirlaw
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Address
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Sleep Disorders Centre Princess Alexandra Hospital Ipswich road Woolloongabba Queensland 4102
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Country
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Australia
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Phone
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+61 7 3176 5751
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Fax
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Email
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[email protected]
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Contact person for public queries
Name
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Teresa Shirlaw
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Address
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Sleep Disorders Centre
Princess Alexandra Hospital
Ipswich road
Woolloongabba Queensland 4102
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Country
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Australia
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Phone
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+61 7 3176 5751
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Fax
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+61 7 3176 7096
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Email
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[email protected]
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Contact person for scientific queries
Name
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Teresa Shirlaw
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Address
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Sleep Disorders Centre
Princess Alexandra Hospital
Ipswich road
Woolloongabba Queensland 4102
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Country
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Australia
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Phone
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+61 7 3176 5751
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Fax
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+61 7 3176 5751
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Email
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[email protected]
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No information has been provided regarding IPD availability
What supporting documents are/will be available?
No Supporting Document Provided
Results publications and other study-related documents
Documents added manually
No documents have been uploaded by study researchers.
Documents added automatically
No additional documents have been identified.
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