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BMJ Open Respir Res. 2019 Apr 29;6(1):e000380. doi: 10.1136/bmjresp-2018-000380. eCollection 2019.

Compliance after switching from CPAP to bilevel for patients with non-compliant OSA: big data analysis.

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ResMed Science Center, San Diego, California, USA.
medXcloud Group, San Diego, California, USA.
HP2 Laboratory, INSERM U1042, Université Grenoble Alpes, Grenoble, France.
EFCR Laboratory, Grenoble Alpes University Hospital, Grenoble, France.
Charles Perkins Centre, School of Medicine, University of Sydney and Royal North Shore Hospital, Sydney, New South Wales, Australia.
Sleep and Ventilation Center Blaubeuren, Lung Center Ulm, Ulm, Germany.
ResMed Science Center, Sydney, New South Wales, Australia.
University of California San Diego, La Jolla, California, USA.



For patients with obstructive sleep apnoea (OSA) who are initially non-compliant with continuous (automatic) positive airway pressure (CPAP/APAP) therapy, a bilevel PAP (Spont/VAuto) therapy transition pathway is available to improve therapy adherence. The aim of this retrospective study was to compare PAP therapy usage data of patients with non-compliant OSA (ncOSA) on CPAP/APAP who were switched to bilevel PAP.


A PAP telemonitoring database was queried between 1 January 2015 and 31 July 2016 for eligible patients started on CPAP/APAP and non-CMS (United States Center for Medicare and Medicaid Services) compliant and switched to bilevel PAP within 90 days of starting CPAP/APAP therapy. PAP therapy data on all patients were compared before switch (CPAP/APAP) and after switch (VAuto/Spont).


Of the 1496 patients with ncOSA identified, 30.3% used CPAP, 62.3% APAP, and 7.4% both APAP and CPAP before switching to a bilevel mode. 47.8% patients switched to Spont mode and 52.2% to VAuto mode. PAP usage significantly improved by 0.9 h/day (p<0.001) and all other device metrics (residual apnoea-hypopnoea index and unintentional mask leak) also improved after the switch. No patients had achieved US CMS criteria for compliance before the switch, and 56.8% did after.


This shows for the first time that there may be potential benefit from switching from CPAP/APAP to bilevel PAP for patients struggling with PAP adherence.


sleep apnoea

Conflict of interest statement

Competing interests: AVB, KV, CMN and JA are all employees of ResMed. J-LDP is supported by the French National Research Agency in the framework of the 'Investissements d’avenir' program (ANR-15-IDEX-02). His department has received research support from Philips Respironics, Fisher and Paykel, and ResMed. PAC has an appointment to an endowed academic Chair at the University of Sydney that was established from ResMed funding. He has received research support from ResMed, SomnoMed and Zephyr Sleep Technologies. He is a consultant/adviser to Zephyr Sleep Technologies, and Narval. He has a pecuniary interest in SomnoMed related to a previous role in R&D (2004). HW has received consulting/speaking fees from ResMed and Inspire Medical. AM relinquished all outside personal income as an Officer of the ATS in 2012. ResMed gave a philanthropic donation to UC San Diego, but AM receives no personal income from ResMed.

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