Pressure-Relief Features of Fixed and Autotitrating Continuous Positive Airway Pressure May Impair Their Efficacy: Evaluation with a Respiratory Bench Model

Zhu, Kaixian; Aouf, Sami; Roisman, Gabriel; Escourrou, P.

doi:10.5664/jcsm.5590

Cited by 15 publications

(5 citation statements)

References 32 publications

(42 reference statements)

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“…Use of an oronasal mask may require higher CPAP levels in comparison to a nasal mask, potentially leading to greater air leak, and CPAP efficacy with different masks may also be subject to effects of body position. [37][38][39] Zhu et al 40 showed that a pressure relief feature on both fixed and autoCPAP may reduce treatment efficacy, with a bench model demonstrating increased residual AHI when this modality is in use. Although our overall numbers were relatively small, there were no differences in mask type or pressure relief settings between the group 1 and group 2 patients in our study.…”

Section: Discussionmentioning

confidence: 99%

Use of the WatchPAT to detect occult residual sleep-disordered breathing in patients on CPAP for obstructive sleep apnea

Epstein

Musa

Chiu

et al. 2020

Journal of Clinical Sleep Medicine

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Study Objectives: To determine the accuracy of the apnea-hypopnea index (AHI) as measured by continuous positive airway pressure (CPAP) machines by simultaneously employing a home sleep apnea testing device (WatchPAT 200, Itamar Medical, Israel [WPAT]) in patients suspected of having residual sleepdisordered breathing (SDB). Methods: Patients with new, recurrent, or worsening signs, symptoms, or comorbidities associated with obstructive sleep apnea underwent home sleep apnea testing using WPAT while simultaneously using CPAP at their usual prescribed settings. CPAP AHI and WPAT AHI, respiratory disturbance index, and oximetry readings were then compared. Results: We identified an elevated AHI with WPAT testing in nearly half of patients with clinically suspected residual SDB and a normal CPAPAHI. WPAT detected additional respiratory events as well, including rapid eye movement-related apneas, respiratory effort-related arousals, and hypoxemia. Conclusions: WPAT AHI was significantly higher than simultaneous CPAP AHI in nearly half of those patients with clinically suspected residual SDB being treated with CPAP. Additional respiratory disturbances, including rapid eye movement-related respiratory events, respiratory effort-related arousals, and hypoxemia, were elucidated only with the use of the WPAT. Residual SDB may have potential clinical consequences, including reduced CPAP adherence, ongoing hypersomnolence, and other health-related sequelae. Simultaneous WPAT testing of patients with a normal CPAP AHI may represent a valuable tool to detect clinically suspected residual SDB or to ensure adequate treatment in high-risk patients with obstructive sleep apnea in general.

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Section: Discussionmentioning

confidence: 99%

Use of the WatchPAT to detect occult residual sleep-disordered breathing in patients on CPAP for obstructive sleep apnea

Epstein

Musa

Chiu

et al. 2020

Journal of Clinical Sleep Medicine

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“…Respironics calls their pressure relief C-Flex, A-Flex, or C-Flex+. Zhu et al (2016) reported the effect of the pressure-relief feature on fixed CPAP and APAP treatment efficacy with a respiratory bench model. They found out pressure-relief features may attenuate CPAP efficacy if not adjusted and calibrated at the beginning of the treatment.…”

Section: Current Pap Technologymentioning

confidence: 99%

Sleep apnea: a review of diagnostic sensors, algorithms, and therapies

et al. 2017

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“…11,12 Several bench studies already compared APAP performance among different manufacturers. [13][14][15][16][17] Only one of them analyzed the addition of simulated UAL, in 2005; but devices have considerably changed and algorithm have been perfected throughout this time. 18 The aim of this study was to investigate the impact of UAL on APAP performance in different simulated apnea events (ie, obstructive apnea, central apnea, and hypopnea) by simulating UAL.…”

Section: Introductionmentioning

confidence: 99%

Impact of Unintentional Air Leaks on Automatic Positive Airway Pressure Device Performance in Simulated Sleep Apnea Events

Fasquel

Yazdani²,

Zaugg³

et al. 2022

Respir Care

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BACKGROUND: Positive airway pressure (PAP) is the accepted standard treatment for obstructive sleep apnea. In the last decades, automatic PAP (APAP) adjustment modes have been increasingly used. Pressure auto adjustment offers better comfort to the patient and represents a valuable help for the clinician to provide optimal treatment. However, device performance differs among manufacturers. Furthermore, the success of the therapy relies greatly on unintentional air leak (UAL) level for many reasons, hence the importance to investigate the performance of the most common devices. The aim of this study was to compare the performance of 3 APAP devices from the most common manufacturers in specific conditions (obstructive sleep apnea, central sleep apnea, hypopnea), with and without UAL. METHODS: This was a bench test study. Performance tests were conducted on a breathing simulator using a Starling resistor, representing the upper airways, and an adjustable UAL valve. Three APAP devices (AirSense 10, DreamStation, and Prisma 20A) were tested in different scenarios. RESULTS: Without UAL, performance of the 3 devices was similar to existing literature. However, performance was altered with the addition of UAL in some scenario. The AirSense 10 was not able to respond correctly to obstructive apnea (intraclass correlation coefficient [ICC] 0.021, P 5 .61) and hypopnea (ICC 0.059, P 5 .26). Prisma 20A lowest performance was seen during simulated obstructive apnea (ICC 0.708, P < .001). DreamStation lowest performance was seen during simulated hypopnea events (ICC 0.755, P < .001). CONCLUSIONS: All 3 APAP devices reacted differently to the added UAL. Performance was altered with some devices, which could affect the therapy success in patients with sleep apnea syndrome. The variability of performance of some APAP devices with UAL should make clinicians evaluate their use in a home setting.

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Pressure-Relief Features of Fixed and Autotitrating Continuous Positive Airway Pressure May Impair Their Efficacy: Evaluation with a Respiratory Bench Model

Cited by 15 publications

References 32 publications

Use of the WatchPAT to detect occult residual sleep-disordered breathing in patients on CPAP for obstructive sleep apnea

Use of the WatchPAT to detect occult residual sleep-disordered breathing in patients on CPAP for obstructive sleep apnea

Sleep apnea: a review of diagnostic sensors, algorithms, and therapies

Impact of Unintentional Air Leaks on Automatic Positive Airway Pressure Device Performance in Simulated Sleep Apnea Events

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