Average Improvement in AHI with EXCITE Therapy
Based on the available evidence, EXCITE (Expiratory Positive Airway Pressure) therapy reduces the Apnea-Hypopnea Index (AHI) by approximately 6.3 to 11.4 events per hour, representing a 28-32% reduction from baseline AHI values. 1
Evidence Analysis
The most recent and comprehensive evidence comes from the 2021 umbrella review published in Sleep Medicine Reviews, which analyzed multiple meta-analyses examining the impact of various interventions on sleep apnea severity. This review specifically evaluated the effectiveness of different therapeutic approaches for obstructive sleep apnea (OSA).
Key Findings on AHI Reduction:
- Four meta-analyses reported absolute AHI reductions with EXCITE therapy ranging from 6.3 events/hour (95% CI: 8.5-4.0) to 11.4 events/hour (95% CI: 13.4-9.4) 1
- This represents a 28-32% reduction in AHI from baseline values 1
- One meta-analysis found a medium-sized AHI reduction with a standardized mean difference of -0.54 (95% CI: -0.87, -0.21) relative to control 1
Comparative Effectiveness:
When compared to other OSA treatments, EXCITE therapy showed:
- Similar AHI reduction (-8.1 events/h) compared to diet-only interventions (-8.6 events/h) and combined diet and exercise interventions (-8.2 events/h) 1
- In a network meta-analysis of 80 RCTs, EXCITE therapy reduced AHI by 17.2 events/h (95% CI: 25.8-8.6), which was not significantly different from diet-induced weight loss (-12.3 events/h) or mandibular advancement devices (-15.2 events/h) 1
- Another network meta-analysis found a more modest reduction of 5.6 events/h (95% CI: -13.1,2.0) 1
Clinical Implications
The effectiveness of EXCITE therapy appears particularly noteworthy because:
- The AHI reduction was achieved without significant reductions in body mass index (BMI) 1
- Beyond AHI improvements, patients experienced reduced daytime sleepiness and improved sleep efficiency 1
- The therapy showed improvements in sleep quality (2.0-point reduction on PSQI) and daytime sleepiness (3.7-point reduction on ESS) 1
Important Considerations
When interpreting AHI values, clinicians should be aware that:
- Different hypopnea scoring definitions can significantly impact reported AHI values 1
- The AASM-recommended 30%/4% hypopnea rule yields substantially lower AHI values than the alternative 50%/3%/AR rule 1
- An AHI of 5/h using the 30%/4% rule would correspond to approximately 10/h using the 50%/3%/AR rule 1
Conclusion
EXCITE therapy offers a clinically significant reduction in AHI, with average improvements of 6.3-11.4 events per hour (28-32% reduction from baseline). This therapy provides a valuable option for OSA management, particularly for patients who may benefit from non-anatomic interventions or those who have failed other treatments.