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This will be a prospective study in subjects with Obstructive Sleep Apnea (OSA) to characterize the clinical performance during a single night of therapy with a FRESCA mask compared with a single night of therapy with their existing nasal Continuous Positive Airway Pressure (CPAP) mask.
Obstructive Sleep Apnea (OSA) is a common chronic disorder and the most common of all sleep disorders. OSA can occur in any age group, but prevalence increases between middle and older age. Over the last two decades the prevalence of sleep disordered breathing seems to be increasing in both men and women, likely due to increasing rates of obesity. Relative increases reported are between 14% and 55% depending on the subgroup. For men, the current prevalence estimates of moderate to severe sleep-disordered breathing are 10% for 30 to 49 year-olds and 17% for 50 to 70 year-olds. For women, the corresponding prevalence estimates are 3% and 9%.
Common consequences of OSA include daytime sleepiness, extreme daytime fatigue, slow reaction time, moodiness, belligerence and vision problems. OSA is also linked to hypertension, increased cardiovascular morbidity, type 2 diabetes, neurocognitive dysfunction and possibly cancer.
The study is a prospective, comparative, open label, randomized crossover assignment, multi-center pivotal study.
Up to forty-five (45) subjects will be enrolled. It is desirable to have the subject population distributed across the OSA severity criteria range.
The purpose of this study is to demonstrate that the FRESCA mask is non-inferior to a CPAP nasal mask in maintaining AHI and ODI during a single night of PSG assessment.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| FRESCA mask first night | Experimental | FRESCA mask first night (experimental device) | CPAP second night (active comparator) |
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| CPAP Mask first night | Experimental | CPAP Mask first night (active comparator)| FRESCA mask second night (experimental device) |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| FRESCA mask first night | Device | FRESCA nasal mask first night |
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| Measure | Description | Time Frame |
|---|---|---|
| Apnea Hypopnea Index (AHI) | The Apnea-Hypopnea Index or Apnoea-Hypopnoea Index (AHI) is an index used to indicate the severity of sleep apnea. It is represented by the number of apnea and hypopnea events per hour of sleep. Difference of AHI values between patients who used the FRESCA treatment first versus the CPAP treatment. | per hour |
| Oxygen Desaturation Index (ODI) | The Oxygen Desaturation Index (ODI) is the number of times per hour of sleep that the blood's oxygen level drop by a certain degree from baseline. The ODI is typically measured as part of standard sleep studies, such as a diagnostic polysomnogram, home sleep apnea testing, or with overnight oximetry.Difference of ODI values between patients who used the FRESCA treatment first versus the CPAP treatment. | per hour |
| Measure | Description | Time Frame |
|---|---|---|
| Arousal Index (AI) | The number of arousals per hour; arousals are defined as a change in EEG for at least 3 seconds. | per hour |
| Sleep Efficiency (SE%) | Sleep Efficiency (%) [100 x Total sleep time/ total recording time] reported per treatment |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Atul Malhotra, MD | FRESCA Medical | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Sequoia Sleep Diagnostics | Fresno | California | 93720 | United States | ||
| Complete Sleep Solutions |
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Eleven (11) subjects were not included in the primary analysis due to incomplete data on at least one PSG nights.
mITT Group (subjects completing 2 nights on study with a Valid PSG result) n=36 See section 8.1 of Clinical Study Report (TR 1000-01) for details.
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| ID | Title | Description |
|---|---|---|
| FG000 | FRESCA Mask First - CPAP Second | First night using FRESCA nasal mask and second night using CPAP FRESCA Nasal Mask: FRESCA nasal mask |
| FG001 | CPAP Mask - FRESCA Mask Second | One night using CPAP nasal mask and then second night using FRESCA nasal mask CPAP Nasal Mask: CPAP nasal pillow and nasal mask |
| Title | Milestones | Reasons Not Completed | |||||
|---|---|---|---|---|---|---|---|
| Overall Study |
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| CPAP Mask first night | Device | CPAP Nasal Mask first night |
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| per night |
| Minimum Sleep SpO2 (%) | The minimum O2 level percentage during treatment reported per treatment | per night |
| Mean Sleep SpO2 -(%) | Mean Sleep SpO2 - blood oxygenation level (%) mean value reported per treatment | per night |
| Wakefulness (Min) | Measure of time not sleeping (minutes) | per night |
| Stage N1 (Min) | Stage N1 sleep is an estimate of the degree of sleep fragmentation. | per night |
| Stage N2 (Min) | Stage N2 sleep predominates the sleep stages with 50% of the total sleep time. It follows the Stage N1 sleep and continues to recur throughout the night. | per night |
| Stage N3 (Min) | Stage N3 is considered as 'deep sleep'. It is sometimes referred as slow wave sleep. | per night |
| REM (Min) | The exact function of the REM is uncertain. However, it occupies approximately 25% of the total sleep time. REM sleep cycles occur every 90 to 120 min throughout the night with progressively increasing periods of time. REM sleep is associated with more frequent and longer duration apneas, hypopneas, and severe hypoxemia | per night |
| Murrieta |
| California |
| 92563 |
| United States |
| Broward Research Group | Hollywood | Florida | 33024 | United States |
| CliniLabs, Inc | New York | New York | 10019 | United States |
| SleepMed of South Carolina | Columbia | South Carolina | 29201 | United States |
| COMPLETED |
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| NOT COMPLETED |
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| ID | Title | Description |
|---|---|---|
| BG000 | FRESCA Mask First CPAP Mask Second | One night using FRESCA nasal mask and the second night using patient provided CPAP |
| BG001 | CPAP Mask First and CPAP Mask Second | One night using patient providing CPAP nasal mask and second night using FRESCA mask |
| BG002 | Total | Total of all reporting groups |
| Units | Counts |
|---|---|
| Participants |
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| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Age, Customized | Count of Participants | Participants |
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| Sex: Female, Male | Count of Participants | Participants |
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| Apnea-Hypopnea Index >= 5/hr | Mean | Standard Deviation | events/hour |
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| BMI<= 35 kg/m^2 | Mean | Standard Deviation | kg/m^2 |
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| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | Apnea Hypopnea Index (AHI) | The Apnea-Hypopnea Index or Apnoea-Hypopnoea Index (AHI) is an index used to indicate the severity of sleep apnea. It is represented by the number of apnea and hypopnea events per hour of sleep. Difference of AHI values between patients who used the FRESCA treatment first versus the CPAP treatment. | The population for analysis for the primary outcomes is the modified Intent-to-Treat (mITT) population. This population consists of the enrolled, intent-to-treat population who has evaluable data for both nights of PSG evaluation. | Posted | Mean | Standard Deviation | events per hour | per hour |
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| Primary | Oxygen Desaturation Index (ODI) | The Oxygen Desaturation Index (ODI) is the number of times per hour of sleep that the blood's oxygen level drop by a certain degree from baseline. The ODI is typically measured as part of standard sleep studies, such as a diagnostic polysomnogram, home sleep apnea testing, or with overnight oximetry.Difference of ODI values between patients who used the FRESCA treatment first versus the CPAP treatment. | The population for analysis for the primary outcomes is the modified Intent-to-Treat (mITT) population. This population consists of the enrolled, intent-to-treat population who has evaluable data for both nights of PSG evaluation. | Posted | Mean | Standard Deviation | events per hour | per hour |
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| Secondary | Arousal Index (AI) | The number of arousals per hour; arousals are defined as a change in EEG for at least 3 seconds. | The population for analysis for the primary outcomes is the modified Intent-to-Treat (mITT) population. This population consists of the enrolled, intent-to-treat population who has evaluable data for both nights of PSG evaluation. | Posted | Mean | Standard Deviation | events per hour | per hour |
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| Secondary | Sleep Efficiency (SE%) | Sleep Efficiency (%) [100 x Total sleep time/ total recording time] reported per treatment | The population for analysis for the primary outcomes is the modified Intent-to-Treat (mITT) population. This population consists of the enrolled, intent-to-treat population who has evaluable data for both nights of PSG evaluation. | Posted | Mean | Standard Deviation | percentage of sleep efficiency | per night |
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| Secondary | Minimum Sleep SpO2 (%) | The minimum O2 level percentage during treatment reported per treatment | Posted | Mean | Standard Deviation | percentage of O2 Saturation | per night |
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| Secondary | Mean Sleep SpO2 -(%) | Mean Sleep SpO2 - blood oxygenation level (%) mean value reported per treatment | The population for analysis for the primary outcomes is the modified Intent-to-Treat (mITT) population. This population consists of the enrolled, intent-to-treat population who has evaluable data for both nights of PSG evaluation. | Posted | Mean | Standard Deviation | percentage of O2 Saturation | per night |
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| Secondary | Wakefulness (Min) | Measure of time not sleeping (minutes) | The population for analysis for the primary outcomes is the modified Intent-to-Treat (mITT) population. This population consists of the enrolled, intent-to-treat population who has evaluable data for both nights of PSG evaluation. | Posted | Mean | Standard Deviation | minutes | per night |
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| Secondary | Stage N1 (Min) | Stage N1 sleep is an estimate of the degree of sleep fragmentation. | The population for analysis for the primary outcomes is the modified Intent-to-Treat (mITT) population. This population consists of the enrolled, intent-to-treat population who has evaluable data for both nights of PSG evaluation. | Posted | Mean | Standard Deviation | minutes | per night |
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| Secondary | Stage N2 (Min) | Stage N2 sleep predominates the sleep stages with 50% of the total sleep time. It follows the Stage N1 sleep and continues to recur throughout the night. | The population for analysis for the primary outcomes is the modified Intent-to-Treat (mITT) population. This population consists of the enrolled, intent-to-treat population who has evaluable data for both nights of PSG evaluation. | Posted | Mean | Standard Deviation | minutes | per night |
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| Secondary | Stage N3 (Min) | Stage N3 is considered as 'deep sleep'. It is sometimes referred as slow wave sleep. | The population for analysis for the primary outcomes is the modified Intent-to-Treat (mITT) population. This population consists of the enrolled, intent-to-treat population who has evaluable data for both nights of PSG evaluation. | Posted | Mean | Standard Deviation | minutes | per night |
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| Secondary | REM (Min) | The exact function of the REM is uncertain. However, it occupies approximately 25% of the total sleep time. REM sleep cycles occur every 90 to 120 min throughout the night with progressively increasing periods of time. REM sleep is associated with more frequent and longer duration apneas, hypopneas, and severe hypoxemia | The population for analysis for the primary outcomes is the modified Intent-to-Treat (mITT) population. This population consists of the enrolled, intent-to-treat population who has evaluable data for both nights of PSG evaluation. | Posted | Mean | Standard Deviation | minutes | per night |
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All adverse events were record from the time they occurred.
The 47 participants at risk include the 36 who completed the two sleep nights and the 11 who withdrew early.
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | FRESCA Mask | Each patient used both devices, the analysis of the Adverse Events is recorded for both technology. This arm is associated with the FRESCA Mask. | 0 | 47 | 0 | 47 | 4 | 47 |
| EG001 | CPAP Mask | Each patient used both devices, the analysis of the Adverse Events is recorded for both technology. This arm is associated with the CPAP Mask. | 0 | 47 | 0 | 47 | 0 | 47 |
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| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Difficulty breathing through study device | Respiratory, thoracic and mediastinal disorders | Systematic Assessment |
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| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Robert Lahaderne | FRESCA Medical | 949-542-3535 | rlahaderne@frescamed.com |
| ID | Term |
|---|---|
| D020181 | Sleep Apnea, Obstructive |
| D012891 | Sleep Apnea Syndromes |
| ID | Term |
|---|---|
| D001049 | Apnea |
| D012120 | Respiration Disorders |
| D012140 | Respiratory Tract Diseases |
| D020919 | Sleep Disorders, Intrinsic |
| D020920 | Dyssomnias |
| D012893 | Sleep Wake Disorders |
| D009422 | Nervous System Diseases |
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| age less than 70 years old |
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| Male |
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| Overall |
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The mean AHI is rounded to a single decimal point in the text of the report (3.0 and 2.4, respectively), in order to be consistent with standard reporting of AHI.
| Non-Inferiority |
This analysis was planned to assume a non-inferiority (NI) margin of 5 units and a 1-sided alpha level of 2.5%. A 2-sided 95% confidence interval (CI) was also planned to be provided around the difference between treatments, where non-inferiority would also be demonstrated if the upper bound of the 95% CI is less than or equal to the NI margin of 5 units. In this scenario, the 2-sided 95% CI equates to testing the 1-sided non-inferiority hypothesis. |
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