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CPAP with Pressure Relief during Exhalation (C-Flex+) is as Effective as CPAP in the Treatment of Obstructive Sleep Apnea

Monika Krawietz, Carmen Garcia, Carsten Pilz, Martin Glos, Beate Diecker, Ingo Fietze and Thomas Penzel

Purpose: Continuous positive airway pressure (CPAP) is the accepted therapy for obstructive sleep apnea (OSA). An expiratory pressure relief technology called C-Flex+ has been developed to improve the comfort of CPAP therapy. It provides a 2 mbar lower exhalation pressure and an additional flow-based pressure relief at the beginning of exhalation. The following study was conducted to investigate whether C-Flex+ was as effective as CPAP in treating OSA, and the patients’ preference.

Methods: 60 newly diagnosed patients with OSA completed this double-blind controlled crossover-study. Patients were randomized to one night of C-Flex+ and one of CPAP under full attended polysomnography (PSG). A comfort visual analog scale (VAS) ranging from 0 to 10, with 10 being the highest comfort, was completed by all patients immediately after each PSG.

Results: There was no significant difference between the therapy modes in the apnea/hypopnea index (median 1.5 events/hour (h) with C-Flex+ (interquartile range (IQR) 0.7 to 3.6) vs. 1.7 events/h with CPAP (IQR 0.8 to 3.8), p=0.178). The sleep efficiency, sleep architecture and nocturnal oxygenation were also comparable. Most patients preferred C-Flex+ over CPAP (65%, p<0.001). C-Flex+ earned significantly higher ratings in the VAS (8.1 (7.2 to 9.0) vs. 7.0 (5.1 to 8.8), p<0.001).

Conclusion: C-Flex+ was as effective as CPAP therapy in treating OSA and patients preferred this mode of therapy.