{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T08:47:35Z","timestamp":1789980455148,"version":"4.0.1"},"reference-count":41,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2019,8,12]],"date-time":"2019-08-12T00:00:00Z","timestamp":1565568000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100000272","name":"National Institute for Health Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Respirology"],"published-print":{"date-parts":[[2020,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Background and objective<\/jats:title><jats:p>Continuous positive airway pressure (CPAP) is the most common treatment for obstructive sleep apnoea (OSA), but many patients fail long\u2010term therapy. Bilevel positive airway pressure (BPAP) is a potential alternative. We hypothesized that BPAP could improve treatment adherence and outcomes in patients who cannot tolerate CPAP.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Patients with OSA who failed CPAP (usage\u2009&lt;\u20094 h\/day) and were referred to a tertiary sleep centre between 2014 and 2017 for BPAP were included. Age, gender, body mass index (BMI), co\u2010morbidities, CPAP use and reasons for failure, Epworth Sleepiness Scale (ESS), sleep study data, spirometry data and average maximum nightly compliance were recorded.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 52 patients with OSA requiring CPAP\u2009&gt;\u200915\u2009cm\u2009H<jats:sub>2<\/jats:sub>O (71% male, age: 58 (15) years, BMI: 42.6 (10.1) kg\/m<jats:sup>2<\/jats:sup>, apnoea\u2013hypopnoea index (AHI): 51.1 (30.4)\/h) were studied; 62% had respiratory co\u2010morbidities affecting nocturnal breathing including obesity hypoventilation syndrome and COPD; 25% had neuromuscular conditions; and 17% had cardiovascular disease. CPAP was used for 199 (106\u2013477) days prior to referral for BPAP. Reasons for CPAP failure were intolerant pressures (23%), uncontrolled symptoms (23%), mask problems (21%), adverse effects (13%), claustrophobia (8%), co\u2010morbidities (8%) and other issues (4%). Lower expiratory positive airway pressures were needed with BPAP compared to CPAP (10 (8\u201312) vs 16.8 (15.7\u201319.2) cm\u2009H<jats:sub>2<\/jats:sub>O, <jats:italic>P<\/jats:italic> = 0.001); patients achieved better adherence to BPAP (7.0 (4.0\u20138.5) vs 2.5 (1.6\u20136.7) h\/night, <jats:italic>P<\/jats:italic> = 0.028) and better symptom control (ESS: 4.0 (1.0\u20137.0) vs 10.0 (6.0\u201317.0) points, <jats:italic>P<\/jats:italic> = 0.039).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>In patients with moderate\u2013severe OSA who fail CPAP therapy due to low adherence, BPAP is well tolerated and achieves sufficient control of sleep\u2010disordered breathing and its symptoms.<\/jats:p><\/jats:sec>","DOI":"10.1111\/resp.13674","type":"journal-article","created":{"date-parts":[[2019,8,13]],"date-time":"2019-08-13T00:13:22Z","timestamp":1565655202000},"page":"443-448","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":23,"title":["BPAP is an effective second\u2010line therapy for obese patients with OSA failing regular CPAP: A prospective observational cohort study"],"prefix":"10.1111","volume":"25","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9587-0874","authenticated-orcid":false,"given":"Athanasius","family":"Ishak","sequence":"first","affiliation":[{"name":"Faculty of Life Sciences and Medicine, Centre for Human and Applied Physiological Science (CHAPS) King's College London  London UK"},{"name":"Lane Fox Respiratory Unit Guy's and St Thomas' NHS Foundation Trust  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle","family":"Ramsay","sequence":"additional","affiliation":[{"name":"Lane Fox Respiratory Unit Guy's and St Thomas' NHS Foundation Trust  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas","family":"Hart","sequence":"additional","affiliation":[{"name":"Faculty of Life Sciences and Medicine, Centre for Human and Applied Physiological Science (CHAPS) King's College London  London UK"},{"name":"Lane Fox Respiratory Unit Guy's and St Thomas' NHS Foundation Trust  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joerg","family":"Steier","sequence":"additional","affiliation":[{"name":"Faculty of Life Sciences and Medicine, Centre for Human and Applied Physiological Science (CHAPS) King's College London  London UK"},{"name":"Lane Fox Respiratory Unit Guy's and St Thomas' NHS Foundation Trust  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,8,12]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199304293281704"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kws342"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1152\/jappl.1978.44.6.931"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.10-2614"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1136\/thoraxjnl-2013-203887"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(81)92140-1"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.21037\/jtd.2018.01.39"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.smrv.2011.01.003"},{"key":"e_1_2_9_10_1","doi-asserted-by":"crossref","unstructured":"RanderathWJ VerbraeckenJ AndreasS BettegaG BoudewynsA HamansE JalbertF PaoliJR SannerB SmithIet al.;European Respiratory Society Task Force on Non\u2010CPAP Therapies in Sleep Apnoea. 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