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Sleep Apnea SyndromesPhase 2TURBONCT00503802

Randomized Clinical Trial of Nasal Turbinate Reduction to Improve Continuous Positive Airway Pressure (CPAP) Outcomes for Sleep Apnea

A Phase 2 study testing Radiofrequency Turbinate Reduction in people with Sleep Apnea Syndromes and Nasal Obstruction, run by University of Washington at 3 sites in United States.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

Obstructive sleep apnea occurs in 2-4% of middle age adults and results in significant morbidity and mortality. The first line therapy is provision of continuous positive airway pressure (CPAP) via a nasal mask chronically. Nasal resistance related to nasal turbinate enlargement may compromise CPAP treatment. Read more about this study

Who is it for?
Ages 18 to 80 years
What is being tested?
Radiofrequency Turbinate Reduction
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
242 participants
Where
3 sitesUnited States
Study dates
Jul 2007to Jun 2011
Phase
Phase 2
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 80 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Age 18-80 years
  • Newly diagnosed obstructive sleep apnea (apnea-hypopnea index >= 5 events/hour)
  • CPAP therapy recommended
  • Persistent bilateral inferior turbinate hypertrophy
  • American Society of Anesthesiologists Class I-III
  • Ability to give informed consent
  • Ability and willingness to complete the study protocol
  • Fluency in verbal and written English

Who cannot join

  • Previous surgical turbinate treatment
  • Other nasal disorders (i.e. recurrent epistaxis, desiccated or crusted mucosa, severe bilateral obstructing septal deformity, or obstructing polyposis)
  • Active respiratory tract infections
  • Coagulopathy
  • Severe psychiatric comorbidity (taking anti-psychotic medication)
  • American Society of Anesthesiologists Class IV or V
Show all 10Show fewer
  • Pregnancy
  • No telephone
  • Plans of moving during the study period
  • Known contraindication to lidocaine with epinephrine, oxymetazoline, or acetaminophen

Trial locations and contacts

3 sites in 1 country.

United States3 sites
  • UW Sleep Disorders Center at Harborview Medical Center

    Seattle, Washington, 98104

  • Virginia Mason Medical Center

    Seattle, Washington, 98104

  • University of Washington General Clinical Research Center

    Seattle, Washington, 98195

Other trials in United States

About this study

Official title: Turbinate Reduction & CPAP Use: A Randomized Blinded OSA (TURBO) Trial

Obstructive sleep apnea occurs in 2-4% of middle age adults and results in significant morbidity and mortality. The first line therapy is provision of continuous positive airway pressure (CPAP) via a nasal mask chronically. Nasal resistance related to nasal turbinate enlargement may compromise CPAP treatment. This randomized double-blind sham-placebo-controlled trial tests the hypothesis that nasal turbinate reduction improves the nasal passage, CPAP use, and sleep apnea quality of life in newly diagnosed sleep apnea patients who are recommended CPAP therapy.

Read the detailed description

Obstructive sleep apnea syndrome afflicts at least 2 - 4% of adults and is associated with significant morbidity and mortality. Continuous positive airway pressure (CPAP) therapy is the primary treatment for sleep apnea in adults, but non-adherence to CPAP limits its effectiveness. Even with maximal medical therapy, nasal obstruction is common in sleep apnea patients and may hamper both CPAP adherence and efficacy. However, the most common cause of nasal obstruction in sleep apnea patients (turbinate hypertrophy) is surgically correctable. Treatment of nasal obstruction may lead to more successful use of CPAP. The long-term goal of the proposed research is to develop a novel, multi-disciplinary, multi-modal approach to therapy, in order to improve clinically important treatment outcomes for sleep apnea. The short-term objectives of this proposal are to:

  1. Quantify the effect of nasal turbinate reduction on the nasal airway;
  2. Determine whether turbinate reduction increases CPAP use or efficacy; and
  3. Determine whether turbinate reduction positively influences CPAP treatment outcomes.

We will employ a single-site, randomized, double-blind, sham-placebo-controlled trial to test the hypotheses that turbinate reduction:

  1. increases nasal airway cross-sectional area;
  2. increases mean nightly objective CPAP use; and
  3. improves sleep apnea quality of life 3 months after CPAP titration.

We will use the radiofrequency turbinate reduction surgical technique, which allows ethical randomization and effective blinding. Three, six, and 12 months after turbinate reduction and CPAP titration we will measure the change in the minimal nasal cross-sectional area, level of CPAP use, and improvement in sleep apnea quality of life. Secondary outcomes will capture this treatment's broader impact on the nose, CPAP, and sleep apnea. If turbinate reduction can be shown to improve sleep apnea outcomes through increased use or efficacy of CPAP therapy, this trial will demonstrate the value and effectiveness of a novel, multidisciplinary, combined medical-surgical approach to the management of obstructive sleep apnea syndrome.

Being tested
Radiofrequency Turbinate Reduction, Sham RF
Keywords
Sleep Apnea, Sleep disordered breathing, Nasal Obstruction, Turbinate, Radiofrequency, Continuous positive airway pressure, CPAP, Sleep surgery
Medical subject headings
Sleep Apnea Syndromes, Nasal Obstruction

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Radiofrequency Turbinate ReductionProcedure or surgery

    Radiofrequency Turbinate Reduction

  • Sham RFProcedure or surgery

    The steps of the procedure are as follows: 1) application of topical anesthetic to the turbinate mucosa bilaterally; 2) injection of 1.0 ml of lidocaine 1% with epinephrine 1:100,000 with a 30-gauge needle into each inferior turbinate anteriorly; 3) delay five minutes for local anesthetic to take full effect; 4) re-insertion of the anesthetic needle to check for complete anesthesia on one side, and injection of another 1.0 ml of lidocaine 1% with epinephrine 1:100,000 5) placement of the radiofrequency electrode (23-gauge, 1 cm long) into the inferior turbinate; 6) delivery of 300 Joules of radiofrequency energy to the turbinate over 29 seconds (no energy will be delivered in sham procedure)7) placement of a cotton pledget (soaked in oxymetazoline solution 0.05%) against the treatment site 8) repeat steps 3 - 8 for the contra-lateral inferior turbinate; 9) removal of the cotton pledgets after several minutes; and 11) observation of hemostasis.

Study groups in NCT00503802
Study groupRoleWhat they receive
1Active comparatorActive RF treatment
Receives: Procedure: Radiofrequency Turbinate Reduction
2Sham comparatorSham RF treatment
Receives: Procedure: Sham RF

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Nasal minimum cross-sectional area (measured objectively with acoustic rhinometry)

    Measured: Primary outcome at 3 months, secondary outcomes at 6 and 12 months

  2. CPAP use (measured objectively as pressure-on use)

    Measured: Primary outcome at 3 months, secondary outcomes at 6 and 12 months

  3. Sleep Apnea Quality of Life Index (change measured with Then Test technique)

    Measured: Primary outcome at 3 months, secondary outcomes at 6 and 12 months

Secondary outcomes (5)
  1. Secondary Nasal Outcome Measures: peak inspiratory flow, resistance (rhinomanometry), endoscopy, smell identification test, nasal obstruction symptom evaluation (NOSE) scale, and other nasal treatment history

    Measured: 3, 6, and 12 months

  2. Secondary CPAP Outcome Measures: acceptance, subjective tolerance, pressure, leak, residual breathing events (measured by CPAP device)

    Measured: 3, 6, and 12 months

  3. Secondary Clinical Outcome Objective Measures: vigilance (psychomotor vigilance task monitor), blood pressure, and plasma C-reactive protein (cardiovascular risk biomarker)

    Measured: 3, 6, and 12 months

  4. Secondary Clinical Outcome Subjective Measures: Quality of Life Change, Symptoms of Nocturnal Obstruction & Related Events (SNORE-25) Scale, Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, and Short Form-36 version 2

    Measured: 3, 6, and 12 months

  5. Adverse events

    Measured: Any time research participant reports and scheduled evaluations at 3, 6, and 12 months

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted19 Jul 2007 (estimated)
  2. Study startJul 2007
  3. Primary completionJun 2011
  4. Study completionJun 2011

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 2
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Triple blind
Who is masked
Participant, Care provider, Investigator
Enrolment
242 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT00503802
Sponsor's protocol ID
30678-D
Other IDs
06-3050-D 02, R01HL084139
Acronym
TURBO
Status last verified
Jun 2013
First submitted
17 Jul 2007
Last updated
19 Jun 2013
Results posted
No
Data monitoring committee
Yes

Publications

  • Powell NB, Zonato AI, Weaver EM, Li K, Troell R, Riley RW, Guilleminault C. Radiofrequency treatment of turbinate hypertrophy in subjects using continuous positive airway pressure: a randomized, double-blind, placebo-controlled clinical pilot trial. Laryngoscope. 2001 Oct;111(10):1783-90. doi: 10.1097/00005537-200110000-00023.

    PubMed 11801946
  • Li HY, Engleman H, Hsu CY, Izci B, Vennelle M, Cross M, Douglas NJ. Acoustic reflection for nasal airway measurement in patients with obstructive sleep apnea-hypopnea syndrome. Sleep. 2005 Dec;28(12):1554-9. doi: 10.1093/sleep/28.12.1554.

    PubMed 16408415
  • Sugiura T, Noda A, Nakata S, Yasuda Y, Soga T, Miyata S, Nakai S, Koike Y. Influence of nasal resistance on initial acceptance of continuous positive airway pressure in treatment for obstructive sleep apnea syndrome. Respiration. 2007;74(1):56-60. doi: 10.1159/000089836. Epub 2005 Nov 18.

    PubMed 16299414
  • Lam DJ, James KT, Weaver EM. Comparison of anatomic, physiological, and subjective measures of the nasal airway. Am J Rhinol. 2006 Sep-Oct;20(5):463-70. doi: 10.2500/ajr.2006.20.2940.

    PubMed 17063739
  • Stewart MG, Witsell DL, Smith TL, Weaver EM, Yueh B, Hannley MT. Development and validation of the Nasal Obstruction Symptom Evaluation (NOSE) scale. Otolaryngol Head Neck Surg. 2004 Feb;130(2):157-63. doi: 10.1016/j.otohns.2003.09.016.

    PubMed 14990910
  • Friedman M, Tanyeri H, Lim JW, Landsberg R, Vaidyanathan K, Caldarelli D. Effect of improved nasal breathing on obstructive sleep apnea. Otolaryngol Head Neck Surg. 2000 Jan;122(1):71-4. doi: 10.1016/S0194-5998(00)70147-1.

    PubMed 10629486
  • Hilberg O, Pedersen OF. Acoustic rhinometry: recommendations for technical specifications and standard operating procedures. Rhinol Suppl. 2000 Dec;16:3-17.

    PubMed 11225287
  • Flemons WW, Reimer MA. Development of a disease-specific health-related quality of life questionnaire for sleep apnea. Am J Respir Crit Care Med. 1998 Aug;158(2):494-503. doi: 10.1164/ajrccm.158.2.9712036.

    PubMed 9700127
  • Flemons WW, Reimer MA. Measurement properties of the calgary sleep apnea quality of life index. Am J Respir Crit Care Med. 2002 Jan 15;165(2):159-64. doi: 10.1164/ajrccm.165.2.2010008.

    PubMed 11790647
  • Yokoe T, Minoguchi K, Matsuo H, Oda N, Minoguchi H, Yoshino G, Hirano T, Adachi M. Elevated levels of C-reactive protein and interleukin-6 in patients with obstructive sleep apnea syndrome are decreased by nasal continuous positive airway pressure. Circulation. 2003 Mar 4;107(8):1129-34. doi: 10.1161/01.cir.0000052627.99976.18.

    PubMed 12615790
  • Jara SM, Hopp ML, Weaver EM. Association of Continuous Positive Airway Pressure Treatment With Sexual Quality of Life in Patients With Sleep Apnea: Follow-up Study of a Randomized Clinical Trial. JAMA Otolaryngol Head Neck Surg. 2018 Jul 1;144(7):587-593. doi: 10.1001/jamaoto.2018.0485.

    PubMed 29800001

Questions about this trial

What is this clinical trial studying?

A Phase 2 study testing Radiofrequency Turbinate Reduction in people with Sleep Apnea Syndromes and Nasal Obstruction, run by University of Washington at 3 sites in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 8 inclusion and 10 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 19 Jun 2013. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 3 sites in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 2 studies give the treatment to a larger group to see whether it has the intended effect and to keep checking safety.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Nasal minimum cross-sectional area (measured objectively with acoustic rhinometry) (time frame: Primary outcome at 3 months, secondary outcomes at 6 and 12 months). The study lists 3 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT00503802, which also lists 11 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 19 Jun 2013.

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