Self-adjusting Nasal Continuous Positive Airway Pressure Therapy Based on Measurement of Impedance

Randerath, Winfried; Parys, Kay; Feldmeyer, F.; Sanner, Bernd; Rühle, K.-H.

doi:10.1378/chest.116.4.991

Cited by 51 publications

(32 citation statements)

References 23 publications

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“…The decrease of arousal indices in the presented data did not reach the level of significance because the baseline value was low. This is confirmed by further studies with the device investigated [29, 30]. Therefore, we did not find any result indicating that APAP FOT induces arousals itself.…”

Section: Discussionsupporting

confidence: 84%

Self-Adjusting Continuous Positive Airway Pressure Therapy Based on the Measurement of Impedance

Randerath¹,

Parys²,

Lehmann³

et al. 2000

Respiration

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Background: Measurement of impedance using forced oscillation technique is a sensitive means of detecting airway obstructions, including the obstructive sleep apnea syndrome (OSAS). Objective: The present study was conducted to determine whether treatment with an automated impedance-controlled continuous positive airway pressure (CPAP) device (APAP_FOT) is possible in patients with OSAS, and which is the best range of pressure variation in automatical CPAP treatment. We investigated two modes of APAP_FOT with different pressure ranges: (1) the widest technically possible pressure range and (2) a range with individually defined minimum pressure. Methods: Ten patients [9 men, age 56.6 ±10.5 years, BMI 32.0 ± 4.5 kg/m², apnea/hypopnea index (AHI) 18.2 ± 13.3 /h] had a diagnostic polysomnography (baseline). After manual titration of positive airway pressure they were submitted, in randomized order, to two modes of the APAP_FOT device, namely pressure range of 4.0– 15.5 mbar (mode 1 free range) and an individually fixed higher minimum pressure with a maximum pressure of 15.5 mbar (mode 2). Results: While the manually titrated pressure was 8.0 ± 1.3 mbar, in mode 1 it was 5.6 ± 2.1 mbar (p < 0.01); in mode 2 7.3 ± 1.6 mbar (p < 0.05). Both of these modes suppressed abnormal respiratory events (baseline AHI 18.2 ± 13.3/h; mode 1: 2.5 ± 1.9; mode 2: 1.8 ± 0.7, p < 0.01 in each case), and increased slow wave sleep (baseline: 10.6 ± 8.0%, mode 1: 20.2 ± 10.4%, p < 0.05; mode 2: 22.3 ± 9.3%, p < 0.01). In mode 1, the pressure was lower than that titrated manually in 73.2% of total sleep time, in mode 2 in 48.6%, while pressures higher than those derived manually were observed in 13.0% in mode 1 and in 19.1% in mode 2. Conclusions: The data indicate that impedance-controlled CPAP (APAP_FOT) allows adequate treatment of OSAS patients at significantly lower pressures as compared with manually titrated pressure. Differences between the two modes are only minor.

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Section: Discussionsupporting

confidence: 84%

Self-Adjusting Continuous Positive Airway Pressure Therapy Based on the Measurement of Impedance

Randerath¹,

Parys²,

Lehmann³

et al. 2000

Respiration

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“…Monitoring of Zrs may be a useful complementary tool in the adaptation of ventilator settings during invasive and noninvasive ventilation [130][131][132][133][134][135]. The FOT has also been used to improve the diagnosis of sleep disturbances [136] and to determine the optimal continuous positive airway pressure (CPAP) level required to treat obstructive sleep apnoea [137][138][139][140]. In sleep studies, changes of Zrs along the breathing cycle are followed, since obstructive sleep apnoeas/hypopnoeas are characterised by marked changes within the breathing cycle [138].…”

Section: Applications Of Forced Oscillation Technique In Monitoring Rmentioning

confidence: 99%

The forced oscillation technique in clinical practice: methodology, recommendations and future developments

Oostveen¹,

MacLeod²,

Lorino³

et al. 2003

European Respiratory Journal

1,089

1,120

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The forced oscillation technique (FOT) is a noninvasive method with which to measure respiratory mechanics. FOT employs small-amplitude pressure oscillations superimposed on the normal breathing and therefore has the advantage over conventional lung function techniques that it does not require the performance of respiratory manoeuvres.The present European Respiratory Society Task Force Report describes the basic principle of the technique and gives guidelines for the application and interpretation of FOT as a routine lung function test in the clinical setting, for both adult and paediatric populations.FOT data, especially those measured at the lower frequencies, are sensitive to airway obstruction, but do not discriminate between obstructive and restrictive lung disorders. There is no consensus regarding the sensitivity of FOT for bronchodilation testing in adults. Values of respiratory resistance have proved sensitive to bronchodilation in children, although the reported cutoff levels remain to be confirmed in future studies.Forced oscillation technique is a reliable method in the assessment of bronchial hyperresponsiveness in adults and children. Moreover, in contrast with spirometry where a deep inspiration is needed, forced oscillation technique does not modify the airway smooth muscle tone. Forced oscillation technique has been shown to be as sensitive as spirometry in detecting impairments of lung function due to smoking or exposure to occupational hazards. Together with the minimal requirement for the subject9s cooperation, this makes forced oscillation technique an ideal lung function test for epidemiological and field studies. Novel applications of forced oscillation technique in the clinical setting include the monitoring of respiratory mechanics during mechanical ventilation and sleep.

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“…In contrast to the fixed pressure level during conventional CPAP therapy, APAP devices adjust the pressure within a determined range according to the needs of the patients, thereby reducing the mean pressure applied during the night [8]. Randomized controlled trials comparing CPAP with APAP have recently demonstrated that APAP therapy is as effective as CPAP in reducing obstructive events and improving sleep quality and daytime hypersomnolence [9,10,11,12].…”

Section: Introductionmentioning

confidence: 99%

Comparison of Automatic and Continuous Positive Airway Pressure in a Night-by-Night Analysis: A Randomized, Crossover Study

et al. 2006

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Background: Long-term compliance is suboptimal in the treatment of the obstructive sleep apnea syndrome (OSAS). Objectives: We compared the efficacy of and the adherence to automatic continuous positive airway pressure (APAP) and constant continuous positive airway pressure (CPAP) based on a night-by-night analysis. Methods: We performed a randomized, single-blind crossover study in 20 patients with moderate-to-severe OSAS. After diagnostic polysomnography and manual titration, patients were treated for 8 weeks with both constant CPAP and APAP in random order. Compliance and leakage were analyzed night by night using the software LOGSoft® of the Magellan® iPAP device. Results: The reduction in the apnea/hypopnea index (baseline 32.9 ± 19.1/h, CPAP 4.6 ± 2.9/h, APAP 5.6 ± 3.6/h; p < 0.001 compared to baseline) and the Epworth Sleepiness Scale (baseline 10.3 ± 5.7, CPAP 6.6 ± 4.8, APAP 4.9 ± 4.6; p < 0.001 compared to baseline) did not significantly differ between the treatment modes. Leakage time and compliance per night were not statistically different (leakage CPAP 31 ± 57 min, APAP 25 ± 49 min; compliance CPAP 383 ± 116 min, APAP 382 ± 107 min). There was no correlation between leakage and compliance. Thirteen patients (65%) preferred APAP at the end of the study. Conclusions: Treatment efficacy and adherence are similar with CPAP and APAP. There is a trend towards lower leakage with APAP therapy. Patients prefer the automatic mode to fixed pressure.

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Self-adjusting Nasal Continuous Positive Airway Pressure Therapy Based on Measurement of Impedance

Cited by 51 publications

References 23 publications

Self-Adjusting Continuous Positive Airway Pressure Therapy Based on the Measurement of Impedance

Self-Adjusting Continuous Positive Airway Pressure Therapy Based on the Measurement of Impedance

The forced oscillation technique in clinical practice: methodology, recommendations and future developments

Comparison of Automatic and Continuous Positive Airway Pressure in a Night-by-Night Analysis: A Randomized, Crossover Study

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