Validation of the System One RemStar Auto A-Flex for Obstructive Sleep Apnea Treatment and Detection of Residual Apnea-Hypopnea Index: A European Randomized Trial

Gagnadoux, Frédéric; Pevernagie, Dirk; Jennum, Poul; Løn, Nina; Loiodice, Corinne; Tamisier, Renaud; Mierlo, Petra van; Trzépizur, Wojciech; Neddermann, Martina; Machleit, Annika; Jasko, Jeff; Pépin, Jean‐Louis

doi:10.5664/jcsm.6464

Cited by 27 publications

(14 citation statements)

References 31 publications

(45 reference statements)

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“…In our study, visual analysis allowed us to identify and exclude pressure values related to those events. In addition, the rAHI value in this type of devices is reliable when < 10 events/hour is recorded, as compared to manual titration by PSG [27]. Our results, however, cannot be extrapolated to all available algorithms because of potential marked variations in the performance of each device.…”

Section: Discussionmentioning

confidence: 88%

Impact of Mask Type on the Effectiveness of and Adherence to Unattended Home-Based CPAP Titration

et al. 2019

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Objectives. To compare interfaces performance during home-based automatic titration (APAP). Methods. Retrospective study based on APAP titration from Obstructive Sleep Apnea Syndrome (OSA) patients. Results. 707 patients, 513 men (70.6%), were titrated. Masks were 104 pillows (14.7%), group I (GI); 532 nasal (75.2%), group II (GII); and 71 oronasal masks (10%), group III (GIII). We found differences in effective pressure to the device (P90/P95) (GI: 7.13±1.9 vs. GII: 8.3±2.1 vs. GIII: 9.3±2.6 cmH2O, p <0.001) but not in final pressure titrated manually (GI: 7.9±1.4 vs. GII: 8.6±1.6 vs. GIII: 9.2±1.9 cm of H2O, p >0.5), where lower residual AHI for pillows was p <0.001 and leaks for nasal were p <0.001. No differences were found in compliance (hours) (GI: 6.3±1.2 vs. GII: 6.2±1.1 vs. GIII: 6.1±1.0, p <0.4). Conclusion. During auto-adjusting titration by CPAP-naïve patients, nasal masks had lower leak rates and nasal pillows presented a similar performance.

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Section: Discussionmentioning

confidence: 88%

Impact of Mask Type on the Effectiveness of and Adherence to Unattended Home-Based CPAP Titration

et al. 2019

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“…Основными анализируемыми параметрами являлись: 1) среднее время СРАР-терапии за все дни использования (AU) (ч/ночь) -индекс, отражающий воспроизводимость СРАР-терапии при домашнем использовании; 2) среднее значение лечебного давления СРАРтерапии (CMP) (мбар) -индекс, отражающий уровень лечебного давления СРАР-терапии; 3) среднее значение коррекционного индекса апноэ-гипопноэ при проведении СРАР-терапии (AHI срар ) (соб./час)индекс, отражающий эффективность СРАР-терапии. По уровню использования ночной СРАР-терапии с функцией авто-адаптации к вдоху и выдоху пациента (A-Flex) пациенты разделялись: 1) <4 часов/ночьнизко комплаентные пациенты ОАС (группа «А»); 2) от 4 до 6 часов/ночь -средне комплаентные пациенты ОАС (группа «Б»); 3) >6 часов/ночь -высоко комплаентные пациенты ОАС (группа «В») [15].…”

Section: оценка комплаенса к срар-терапииunclassified

Blood Pressure and Arterial Stiffness Dynamics Depending on the Duration of Cpap Night Sessions in Patients With Severe Obstructive Sleep Apnea

Горбунова¹,

Бабак²,

Адашева³

et al. 2019

Arhivʺ vnutrennej mediciny

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Background: Numerous studies on the pathophysiological mechanisms of obstructive sleep apnea discover the relationship between obstructive sleep apnea and cardiovascular diseases, its contribution to the development of resistant hypertension and endothelial remodeling. Continuous Positive Airway Pressure (CPAP) is the only reasonable pathogenetic therapy in these patients. This treatment regimen implies the creation of a “pneumatic stent” with a given level of positive pressure on the inhalation and exhalation of the patient, allowing to stabilize the lumen of the upper respiratory tract and prevent the pharyngeal collapse. However, the effects and the required duration of CPAP of night sessions to achieve the target values of blood pressure and restore arterial stiffness in patients with severe obstructive sleep apnea with resistant hypertension remain poorly understood. Objective: to study the dynamics of blood pressure, arterial stiffness and endothelial dysfunction in patients with severe obstructive sleep apnea with resistant hypertension, depending on the duration of auto-adjusting CPAP (A-Flex therapy). Methods: the prospective single-center study enrolled 168 patients with obstructive sleep apnea with resistant hypertension (139 males, 46,6 ± 9,0 y. o.) with apnea-hypopnea index >30 events /hour. The night polygraphy study was performed to calculate AHI, oxygen desaturation index, mean nocturnal saturation (SpO2 ) according to the requirements of American Academy of Sleep Medicine. Endothelial function of blood vessels was assessed manually to peripheral arterial tone. The reactive hyperemia index and augmentation index was calculated. Blood pressure was monitored by office measurement, daily monitoring of blood pressure, and by individual patient diaries. Optimal level of CPAP-treatment was adjusted at home. Apnea-hypopnea index, the level of air leakage, average pressure and compliance to CPAP-therapy were established in accordance with international requirements. Results: In the group of patients, treated with night sessions of A-Flex > 6 h/night, significant dynamics was observed by the 6th month of treatment. That is, a decrease in RHI by -1.33 (95% CI from -2.25 to -0.41; P = 0.002), a decrease in AI by -12.4% (95% CI from -18.42 to -6.38; P = 0.001), a decrease in mean SBP (24 h) by -33.6 mm Hg (95% CI from -44.1 to -23.2; P = 0.002) and decrease in mean DBP (24 h) by -20.2 mm Hg (95% CI from -29.4 to -11.1; P = 0.001), with a decrease in rate of morning rise of SPB by -22.4 mm Hg/h (95% CI from -24.7 to -20.1; P = 0.002) and a decrease in rate of morning rise of DPB by -17.4 mm Hg/h (95% CI from -19.5 to -15.3; P = 0.003). The best target values were achieved by the 12th month of treatment: a decrease in RHI by -2.11 (95% CI from -2.57 to -1.65; P = 0.001), a decrease in AI by -28.5% (95% CI from -37.06 to -19.94; P = 0.002), a decrease in mean SBP (24 h) by -39.7 mm Hg (95% CI from -48.9 to -30.5; P = 0.001) and decrease in mean DBP (24 h) by -26.8 mm Hg (95% CI from -36.1 to -17.5; P = 0.001), with a decrease in rate of morning rise of SPB by -22.5 mm Hg/h (95% CI from -23.6 to -21.4; P = 0.001) and a decrease in rate of morning rise of DPB by -19.4 mm Hg/h (95% CI from -20.7 to -18.1; P = 0.002). Conclusions: in patients with severe obstructive sleep apnea and resistant hypertension only CPAP-therapy in the A-Flex mode > 6 h/night allows to achieve target blood pressure, restores endothelial function and arterial stiffness, therefore reducing the risks of cardiovascular complications.

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“…It measures changes in airflow by an internal pneumotachograph to identify respiratory events. If flow decreases by 40% to 80% for at least 10 sec, the event is labeled a hypopnea; a decrease in flow by more than 80% for at least 10 sec is labeled an apnea [9,10]. The device starts off at the minimum pressure set point for five minutes.…”

Section: Auto-cpap Studiesmentioning

confidence: 99%

Can Auto-CPAP Determine Therapeutic CPAP Pressure in Children with OSA?

Opasatian¹,

Preutthipan²

2018

J Sleep Disord Ther

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Objective: In current standard practice the therapeutic pressure of CPAP is determined by manually titration under attended polysomnography (PSG). Since PSG is not easily accessible, auto-CPAP may be an attractive alternative. Our goal is to compare the pressure levels obtained from home auto-CPAP with overnight PSG titration in children with OSA. Methods: We performed a prospective cohort study in 2-18 year-old children with OSA referred for CPAP titration under PSG. Children were instructed to use auto-CPAP devices at home for 8 weeks, either before or after PSG titration. One night PSG titration was performed following AASM clinical guidelines for the manual titration of positive airway pressure. Data from only those children who used auto-CPAP ≥ 4 hours per day, for >consecutive 7 days and percent days with device usage ≥ 80% were selected for analysis. Average device pressure ≤ 90% of time from auto-CPAP were obtained and compared with PSG titrating pressure. Results: Eleven of 17 children were enrolled and completed the protocol (male 9/11, aged 9.6 ± 4.2 years, BMI 31.5 ± 10.0 kg/m 2). Three children refused to use auto-CPAP. Three children were non-adherence. Six of 11 children had already undergone adenotonsillectomy. There were no significant differences in the pressure levels obtained from home auto-CPAP and PSG titration (11.05 ± 3.68 vs. 11.18 ± 3.34 cm H 2 O, p=0.84). However, when considering on actual values of the pressure, only 5/11 children had pressure differences <2 cm H 2 O. Pressure levels obtained from auto-CPAP significantly differed from PSG titration in the group of children with history of adenotonsillectomy (p=0.036). Conclusion: In children with OSA, the use of home auto-CPAP may not accurately determine the therapeutic CPAP pressure as compared with manually titration under attended PSG, especially in children who previously had adenotonsillectomy.

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Validation of the System One RemStar Auto A-Flex for Obstructive Sleep Apnea Treatment and Detection of Residual Apnea-Hypopnea Index: A European Randomized Trial

Abstract: A commentary on this article appears in this issue on page 167.

Cited by 27 publications

References 31 publications

Impact of Mask Type on the Effectiveness of and Adherence to Unattended Home-Based CPAP Titration

Impact of Mask Type on the Effectiveness of and Adherence to Unattended Home-Based CPAP Titration

Blood Pressure and Arterial Stiffness Dynamics Depending on the Duration of Cpap Night Sessions in Patients With Severe Obstructive Sleep Apnea

Can Auto-CPAP Determine Therapeutic CPAP Pressure in Children with OSA?

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