What is the American Academy of Sleep Medicine (AASM) stance on Expiratory Positive Airway Pressure (EPAP) devices, such as EXCITE, for the treatment of Obstructive Sleep Apnea (OSA)?

AASM Stance on EPAP Devices (EXCITE) for OSA Treatment

The American Academy of Sleep Medicine (AASM) does not specifically recommend EPAP devices such as EXCITE as first-line therapy for OSA, instead strongly recommending either CPAP or APAP as the primary treatment options for obstructive sleep apnea. 1

AASM Recommended First-Line Treatments for OSA

• The AASM strongly recommends positive airway pressure (PAP) therapy as the first-line treatment for OSA in adults with excessive sleepiness 1
• Both CPAP and APAP are equally recommended as primary treatment options for OSA 1, 2
• PAP therapy can be initiated using either APAP at home or in-laboratory PAP titration in adults with OSA who have no significant comorbidities 1, 2
• The AASM suggests using CPAP or APAP over BPAP in the routine treatment of OSA in adults (conditional recommendation) 1

AASM Guidance on Alternative Therapies

• For patients who cannot tolerate or adhere to PAP therapy, the AASM recognizes alternative treatment options including mandibular advancement devices (MADs), particularly for mild to moderate OSA 2
• The AASM guidelines do not specifically mention or recommend EPAP devices such as EXCITE in their current practice parameters for OSA treatment 1
• When considering alternatives to PAP therapy, the AASM emphasizes that treatment decisions should prioritize improvement in morbidity, mortality, and quality of life outcomes 2, 3

Research on EPAP Devices

• Limited research suggests that EPAP nasal devices may reduce the apnea/hypopnea index (AHI) and daytime sleepiness in some patients with OSA 4
• Some patients may prefer EPAP to CPAP, though CPAP more effectively improves sleep apnea parameters 4
• Research indicates that patients with mild to moderate OSA who do not tolerate CPAP might be appropriate candidates for EPAP therapy 4
• However, there are few well-designed clinical trials evaluating the efficacy of EPAP devices, and they are not mentioned in current AASM guidelines 4

Implementation of OSA Treatment

• The AASM emphasizes that treatment of OSA should be based on a diagnosis established using objective sleep apnea testing 1
• Adequate follow-up, including troubleshooting and monitoring of objective efficacy and usage data, is essential following any OSA therapy initiation 1, 2
• Educational interventions at therapy initiation are strongly recommended to improve adherence 1, 2
• Behavioral and troubleshooting interventions during the initial period of therapy are suggested to optimize treatment outcomes 1

Clinical Considerations

• While some patients may not tolerate CPAP therapy, the AASM guidelines do not currently position EPAP devices as an approved or recommended alternative 1
• When considering alternatives to CPAP/APAP, clinicians should prioritize therapies with stronger evidence supporting improvements in clinically significant outcomes 2
• The lack of specific mention of EPAP devices in current AASM guidelines suggests insufficient evidence to support their routine use in clinical practice 1