Auto-Bilevel Positive Airway Pressure Therapy For Aerophagia During Obstructive Sleep Apnea Management

Document Type

Conference Proceeding

Publication Date

10-2025

Publication Title

Chest

Abstract

INTRODUCTION: Continues Positive Airway Pressure (CPAP) has been the mainstay of treatment for Obstructive Sleep Apnea (OSA). A well-known side effect of CPAP is aerophagia (1). CPAP therapy is successful in two-thirds of the people and one of the reasons for CPAP failure is aerophagia. The pressurized air is swallowed in the gastrointestinal system causing belching, abdominal distention, flatulence and discomfort (2). Aerophagia is common in patients on CPAP therapy with one study reporting a prevalence of 52% (1). CASE PRESENTATION: A 48-year-old female with a past medical history of juvenile rheumatoid arthritis on adalimumab and methotrexate, body mass index of 20 kg/m2 and known diagnosis of severe OSA on Bilevel Positive Airway Pressure (BPAP) of 15/8 cm H2O using full face mask presented for a second opinion after multiple sleep studies for evaluation for BPAP related aerophagia. Her symptoms included belching and flatulence, forcing her to wake up six times every night. She was initially diagnosed via a home sleep apnea testing study showing an Apnea/Hypopnea index (AHI) of 55.8/hr with supine AHI being 70.9/hr. Her initial treatment was with CPAP with pressure of 9 cm H2O but due to aerophagia she underwent three further titration studies to find an optimal pressure support which could control her AHI without worsening her aerophagia. Her BPAP settings in the past ranged from 9/4 cm H2O to as high as 16/9 cm H2O. At her clinic visit, her BPAP settings were adjusted to Auto BPAP with a maximum Inspiratory Positive Airway Pressure (IPAP) of 14 cm H2O and a minimum Expiratory Positive Airway pressure (EPAP) of 5 cm H2O, with a pressure support of 6 cm H2O. She was also advised positional therapy and at the next visit her aerophagia resolved with a controlled AHI of 1/hr. DISCUSSION: BPAP reduces the mean airway pressure due to the pressure changes from IPAP to EPAP which can make it more comfortable for patients during exhalation (3). It can be used as an alternative in patients who are intolerant to CPAP as it can improve adherence and improve symptoms (4). Our patient had tried multiple different BPAP settings, had multiple titration studies but still had persistent aerophagia. She was trialed on Auto BPAP with successful resolution of aerophagia along with a controlled AHI indicating Auto BPAP can be an effective tool for controlling this adverse effect of positive pressure therapy (PAP). CONCLUSIONS: Auto BPAP can be an effective tool to control aerophagia in patients on PAP therapy for OSA.

Volume

168

Issue

4S

First Page

7088A

Last Page

7089A

Comments

American College of Chest Physicians CHEST Annual Meeting, October 19-22, 2025, Chicago, IL

DOI

10.1016/j.chest.2025.07.3977

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