Expiratory positive airway pressure (EPAP) devices create backpressure from a user’s own breath to keep airways open for obstructive sleep apnea (OSA) patients. Unlike CPAP, which delivers a constant stream of air throughout the respiratory cycle, EPAP devices only resist airflow during expiration. EPAP is most commonly delivered via small devices using a valve system to create resistance upon exhalation while allowing unobstructed inhalation. Also, EPAPs do not require a power source and typically fit in the palm of a hand.
However, EPAPs efficacy tends to be lower than CPAP. Ideal candidates are often those with positional or mild OSA who cannot tolerate CPAP. Additionally, EPAP may be considered for use in combination therapy or for patients with residual OSA despite other treatments.
This guide compares EPAP devices on specifications including sizes, materials, warranty, payor coverage, cleaning instructions, and supporting studies.
The EPAPs compared are:
AirAvant Medical Bongo Rx
BRYGGS Medical LLC ULTepap
CPAPNEA Medical Supply Optipillows EPAP Mask
Open Airway Dental Solutions Ltd ExVent (pending FDA clearance)
| Company: | AirAvant Medical | BRYGGS Medical LLC | CPAPNEA Medical Supply | Open Airway Dental Solutions LLC |
|---|---|---|---|---|
| EPAP: | Bongo Rx | ULTepap | Optipillows EPAP Mask | ExVent |
| Website: | www.bongorx.com | www.bryggsmedical.com | www.optipillows.com | www.openairway.com |
| FDA-Cleared Indications: | mild to moderate OSA | mild to moderate OSA | snoring | pending FDA clearance – available in Canada |
| Description: | FDA-cleared, clinically tested, prescription EPAP device for OSA. Soft nasal seals also create nasal dilation. Reusable. Requires no machine or power. Very small, simple to use and requires no assembly. Can be worn with or without headgear. User-friendly option for noncompliant CPAP patients or for travel. Comes with drying stand and travel case. Designed & made in the USA. | Reusable EPAP device with a three-year warranty on the valves. | Optipillows EPAP Mask allows users to adjust the resistance to fit their specific pressure requirements (1.5-14.5 cm H2O). Optipillows was designed by a sleep physician, is comfortable, quiet, reusable, optimal for travel, economical, and requires no prescription. Kits include the patented valve, adjustable headgear, and 3 sizes of nasal pillows. Replace annually. | ExVent, used in combination with O2Vent Optima oral appliance, has a valve that opens fully on inhalation for unrestrictive air flow. It closes on exhalation, directing the breathe through air vents, creating resistance. |
| Available Through Prescription: | Yes | Yes | No | Yes |
| Available Over-the-Counter: | No | No | Yes | No |
| Sizes: | S, M, L, XL included in starter kit | S, M, L | 3 sizes of nasal pillows + adjustable headstrap included in kit | Low, Medium, High |
| Pressure (cm H2O): | up to 15 (fixed) | 0-20 (fixed) | 1.5-14.5 (adjustable via side vent) | 0-7.5 |
| Materials: | silicone nasal seals with polycarbonate valve housings | silicon nasal pillows and polycarbonate valves | nonallergenic plastic and silicone | nylon and silicone |
| Warranty (days): | 90 | 90 (pillows); 1,095 (valves) | 30 | N/A |
| Payor Coverage: | cash pay; FSA/HSA covered | cash pay | MSRP/MAP $119 | O2Vent Optima / Mini oral appliance has payor coverage |
| Reusable: | Yes | Yes | Yes | Yes |
| How to Clean: | Clean with mild soap and water. No disassembly required. | Warm, soapy water; rinse and air dry. | Clean with mild soap and water. | Wash and dry. |
| Supporting Study: | Clinically studied with patients using Bongo at home and in-lab PSGs, with and without Bongo, to demonstrate AHI reduction. Study reviewed by FDA and presented at SLEEP 2019. | Sleeper G, Rashidi M, Strohl KP, et al. Comparison of expiratory pressures generated by four different EPAP devices in a laboratory bench setting. Sleep Med. 2022 Aug;96:87-92. | Hakim TS, et al. EPAP devices Optipillows, Bongo Rx, and Theravent: Flow resistance and the pressures they generate. J Sleep Med Disord. 2021;7(1):1119. | www.openairway.com/blogs |
EPAP therapy Provent was discontinued in 2020. Information in this guide based on data submitted by EPAP marketers. Sleep Review strives for accuracy in all data but cannot be held responsible for claims made by marketers. All devices may not be included. Email editor[at]sleepreviewmag.com to be considered for the next update.
