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Borsini E, Blanco M, Nigro CA. Formulas to predict continuous positive airway pressure level using a home auto-adjusting device for obstructive sleep apnea treatment. Sleep Breath 2024:10.1007/s11325-024-03104-2. [PMID: 39073667 DOI: 10.1007/s11325-024-03104-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 06/12/2024] [Accepted: 07/01/2024] [Indexed: 07/30/2024]
Abstract
PURPOSE To develop equations to predict therapeutic continuous positive airway pressure (CPAPT) based on home-based CPAP titration, including the type of interface used. METHOD Retrospective study conducted in adult patients with obstructive sleep apnea (OSA) who used home-based autoCPAP titration (AutoSet S10, ResMed®). CPAPT was obtained manually through a visual analysis of autoCPAP data (CPAPV) and automatically using the 95th percentile pressure (CPAPP95). Multiple linear regression and K-fold cross-validation were applied. Independent variables were AHI, neck circumference (NC), BMI, and mask. Two formulas were generated based on mask and the Miljeteig and Hoffstein formula. RESULTS We included 702 patients (174 women), median age, BMI and AHI of 58 years, 32 kg/m2 and 32 ev/h, respectively. Predictors for CPAPv (M1) were BMI, NC, AHI and type of interface (R2: 0.19); and for CPAPP95 (M2), BMI, AHI and mask (R2: 0.09). Error and precision between the formulas and CPAPT were: 0 (CPAPV/CPAPP95), and - 3.2 to 3.2 (CPAPV) and - 4 to 4 cm H2O (CPAPP95). CPAPV was higher with oronasal mask (10 vs. 9 cm H2O, p < 0.01). Accuracy defined as; a difference ± 2 cm H2O between estimated CPAP and CPAPT was greater in M1 than in M2 (79% vs. 64%, p < 0.01). CONCLUSION In both models, calculated error was close to zero. CPAPV (± 3.2 cm H2O) showed more precision than CPAPP95 (± 4 cm H2O). With M1 (CPAPV), 79% of patients could start CPAP with reasonable accuracy (error of ± 2 cm H2O).
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Affiliation(s)
- Eduardo Borsini
- Sleep and Ventilation Unit, Hospital Británico, Buenos Aires, Argentina.
| | - Magalí Blanco
- Sleep and Ventilation Unit, Hospital Británico, Buenos Aires, Argentina
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2
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Zheng Y, Yee BJ. Sleep well with home automation. Respirology 2023; 28:980-982. [PMID: 37699771 DOI: 10.1111/resp.14601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 08/31/2023] [Indexed: 09/14/2023]
Abstract
See related article
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Affiliation(s)
- Yizhong Zheng
- CIRUS Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Sydney, New South Wales, Australia
- Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Department of Respiratory and Sleep Medicine, St George Hospital, Sydney, New South Wales, Australia
| | - Brendon J Yee
- CIRUS Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Sydney, New South Wales, Australia
- Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine and Human Health Sciences, Macquarie University, Sydney, New South Wales, Australia
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
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3
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Jaffuel D, Mallet JP, Sabil A. Accuracy of continuous positive airway pressure devices: the devil is in the details, the best is yet to come. Sleep Breath 2023; 27:1651-1654. [PMID: 36394693 DOI: 10.1007/s11325-022-02741-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 10/29/2022] [Accepted: 11/04/2022] [Indexed: 11/18/2022]
Affiliation(s)
- Dany Jaffuel
- Department of Respiratory Diseases, CHU Montpellier, 371, Avenue Doyen GiraudMontpellier Cedex 5, 34295, Montpellier, France.
- PhyMedExp, CNRS, INSERM, Montpellier University, Montpellier, France.
| | - Jean-Pierre Mallet
- Department of Respiratory Diseases, CHU Montpellier, 371, Avenue Doyen GiraudMontpellier Cedex 5, 34295, Montpellier, France
- PhyMedExp, CNRS, INSERM, Montpellier University, Montpellier, France
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Fasquel L, Yazdani P, Zaugg C, Barras A, Michotte JB, Correvon N, Contal O. Impact of Unintentional Air Leaks on Automatic Positive Airway Pressure Device Performance in Simulated Sleep Apnea Events. Respir Care 2023; 68:31-37. [PMID: 36347566 PMCID: PMC9993507 DOI: 10.4187/respcare.10065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
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 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 (ie, obstructive sleep apnea, central sleep apnea, hypopnea), with and without unintentional air leak. 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 unintentional air leak valve. Three APAP devices (AirSense 10, DreamStation, and Prisma 20A) were tested in different scenarios. RESULTS Without unintentional air leak, performance of the 3 devices was similar to existing literature. However, performance was altered with the addition of unintentional air leak in some scenario. The AirSense 10 was not able to respond correctly to obstructive apnea (intraclass correlation coefficient [ICC] 0.021, P = .61) and hypopnea (ICC 0.059, P = .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 unintentional air leak. 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 unintentional air leak should make clinicians evaluate their use in a home setting.
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Affiliation(s)
- Lucas Fasquel
- School of Health Sciences, HES-SO University of Applied Sciences and Arts of Western Switzerland, Lausanne, Switzerland; and Physiotherapy Unit, Réseau Hospitalier Neuchâtelois, Pourtalès Hospital, Neuchatel, Switzerland.
| | - Pouyan Yazdani
- School of Health Sciences, HES-SO University of Applied Sciences and Arts of Western Switzerland, Lausanne, Switzerland; and Physiotherapy Unit, Clinique Romande de Réadaptation, Sion, Switzerland
| | - Cindy Zaugg
- School of Health Sciences, HES-SO University of Applied Sciences and Arts of Western Switzerland, Lausanne, Switzerland; and Physiotherapy Unit, Paediatric Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Alyssia Barras
- School of Health Sciences, HES-SO University of Applied Sciences and Arts of Western Switzerland, Lausanne, Switzerland
| | - Jean-Bernard Michotte
- School of Health Sciences, HES-SO University of Applied Sciences and Arts of Western Switzerland, Lausanne, Switzerland
| | - Nils Correvon
- School of Health Sciences, HES-SO University of Applied Sciences and Arts of Western Switzerland, Lausanne, Switzerland; and Physiotherapy Unit, Réseau Hospitalier Neuchâtelois, Pourtalès Hospital, Neuchatel, Switzerland
| | - Olivier Contal
- School of Health Sciences, HES-SO University of Applied Sciences and Arts of Western Switzerland, Lausanne, Switzerland
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Sung CM, Kim HC, Kim J, Kim JG, Lim SC, Shin MH, Nam K, Lee J, Vena D, White DP, Yang HC, Wellman A. Patients with Epiglottic Collapse Are Less Adherent to Autotitrating Positive Airway Pressure Therapy for Obstructive Sleep Apnea. Ann Am Thorac Soc 2022; 19:1907-1912. [PMID: 35969148 PMCID: PMC9667810 DOI: 10.1513/annalsats.202202-118oc] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 07/03/2022] [Indexed: 12/30/2022] Open
Abstract
Rationale: The anatomic orientation of the epiglottis is such that it points in the opposite direction to inspiratory flow, thereby potentially making positive airway pressure (PAP) treatment challenging in patients with epiglottic collapse. However, no previous studies have analyzed PAP adherence in these patients. Objectives: This study aimed to analyze adherence to autotitrating PAP (APAP) treatment in patients with epiglottic collapse. Methods: We performed an age- and sex-matched case-control study. On the basis of their overnight level-I polysomnogram, patients were prescribed APAP in a tertiary hospital between July 2018 and March 2019. The site of airway collapse was diagnosed with drug-induced sleep endoscopy. Demographic factors, sleep questionnaire, polysomnography, and APAP usage statistics were analyzed. Results: Eighteen patients with epiglottic collapse (epi-group) and 36 without epiglottic collapse (control group) were analyzed. We found that 22.8% of patients in the epi-group terminated APAP within 2 weeks, whereas only 2.8% of patients in the control group terminated APAP within 2 weeks (P = 0.048). The percentage of days with usage over 4 hours was significantly lower in the epi-group (64.6% vs. 75.6%; P = 0.008). In addition, the adherence failure rate was 66.7% in the epi-group and 33.3% in the control group (P = 0.039). Patients with epiglottic collapse were also found to have lower body mass index, which is an unfavorable predictor of APAP adherence. Conclusions: This study suggests that patients with epiglottic collapse have a higher APAP adherence failure rate than patients without epiglottic collapse. Thus, patients with epiglottic collapse should be followed closely during treatment, and alternative therapies should probably be considered for these patients.
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Affiliation(s)
- Chung Man Sung
- Department of Otolaryngology-Head and Neck Surgery and Department of Anatomy, Chonnam National University Medical School, Gwangju, South Korea
- Chonnam National University Hospital, Gwangju, South Korea
| | - Hong Chan Kim
- Department of Otolaryngology-Head and Neck Surgery and Department of Anatomy, Chonnam National University Medical School, Gwangju, South Korea
- Chonnam National University Hospital, Gwangju, South Korea
| | - Jisun Kim
- Department of Otolaryngology-Head and Neck Surgery and Department of Anatomy, Chonnam National University Medical School, Gwangju, South Korea
- Chonnam National University Hospital, Gwangju, South Korea
| | - Jae Gu Kim
- Department of Otolaryngology-Head and Neck Surgery and Department of Anatomy, Chonnam National University Medical School, Gwangju, South Korea
- Chonnam National University Hospital, Gwangju, South Korea
| | - Sang Chul Lim
- Department of Otolaryngology-Head and Neck Surgery and Department of Anatomy, Chonnam National University Medical School, Gwangju, South Korea
- Chonnam National University Hospital, Gwangju, South Korea
| | | | - Kwangil Nam
- Department of Anatomy, Chonnam National University Medical School, Hwasun, South Korea
| | - Jongho Lee
- School of Mechanical Engineering, Gwangju Institute of Science and Technology (GIST), Gwangju, South Korea; and
| | - Daniel Vena
- Division of Sleep and Circadian Disorders, Department of Medicine and Neurology, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - David P. White
- Division of Sleep and Circadian Disorders, Department of Medicine and Neurology, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Hyung Chae Yang
- Department of Otolaryngology-Head and Neck Surgery and Department of Anatomy, Chonnam National University Medical School, Gwangju, South Korea
- Chonnam National University Hospital, Gwangju, South Korea
- Division of Sleep and Circadian Disorders, Department of Medicine and Neurology, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Andrew Wellman
- Division of Sleep and Circadian Disorders, Department of Medicine and Neurology, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
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6
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Correvon N, Fasquel L, Yazdani P, Michotte JB, Dugernier J, Contal O. Impact of additional HEPA filter on APAP performance and CPAP pressure level in simulated sleep apnea events. FRONTIERS IN MEDICAL TECHNOLOGY 2022; 4:891390. [PMID: 35968545 PMCID: PMC9364751 DOI: 10.3389/fmedt.2022.891390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 06/29/2022] [Indexed: 11/28/2022] Open
Abstract
Background CPAP is the first line treatment of obstructive sleep apnea. Recently, the use of added filters has been debated following the field safety notice of Philips Respironics™ on potential health risks due to foam degradation used in their ventilators. However, the added resistance of filters has never been analyzed. Objectives The primary aim was to investigate the impact of four different filters on APAP mode performance with and without added unintentional air leaks (UIAL) with two simulated respiratory events. The secondary aim was to assess the pressure drop due to the increased filter resistance at different fixed CPAP pressure levels. Method This is a bench study. Performance tests were performed on a breathing simulator (ASL 5000™) with a DreamStation™ device. To assess the combined effect of UIAL, a controlled valve was added to the setup. Results Without UIAL, the algorithm was able to detect respiratory events and increase pressure level consequently. In the presence of UIAL, the device's response to simulated events was affected. In fixed CPAP mode, the median measured end-expiratory pressure was 6.2 to 10.0% (p < 0.001) below the set pressure with the additional filters. Additional UIAL severely impacted the delivered pressure with a median reduction up to 28.3% (p < 0.001) to the set pressure. Conclusion Despite a slight pressure drop, the APAP algorithm still performed with additional filters when UIAL were avoided. However, the combined effect of added filter resistance and UIAL severely impacted APAP performance and effectively delivered set pressure.
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Affiliation(s)
- Nils Correvon
- School of Health Sciences (HESAV), HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
- *Correspondence: Nils Correvon
| | - Lucas Fasquel
- School of Health Sciences (HESAV), HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
- Physiotherapy Unit, Réseau Hospitalier Neuchâtelois (RHNe), Pourtalès Hospital, Neuchâtel, Switzerland
| | - Pouyan Yazdani
- School of Health Sciences (HESAV), HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
- Physiotherapy Unit, Clinique Romande de Réadaptation (CRR), Sion, Switzerland
| | - Jean-Bernard Michotte
- School of Health Sciences (HESAV), HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
| | - Jonathan Dugernier
- Physiotherapy Unit, Réseau Hospitalier Neuchâtelois (RHNe), Pourtalès Hospital, Neuchâtel, Switzerland
| | - Olivier Contal
- School of Health Sciences (HESAV), HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
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7
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El-Solh AA, Rudraraju A, Pasrija D, Bui H. Pharmacotherapy of residual excessive sleepiness among continuous positive airway pressure (CPAP) treated patients with sleep apnea. Expert Opin Pharmacother 2022; 23:507-516. [PMID: 35045769 DOI: 10.1080/14656566.2022.2029408] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Patients with persistent sleepiness after adequate treatment of obstructive sleep apnea (OSA) with nasal continuous positive airway pressure (nCPAP) experience impaired cognition, reduced productivity, and worse quality of life. Although the mechanisms responsible for this phenomenon are not completely understood, neuroimaging studies have identified reduced gray matter in the frontal cortex and alterations in white matter integrity suggestive of axonal and myelin damage. The intermittent hypoxia with resulting oxidative injury is considered a prime culprit behind the loss of wake-promoting catecholaminergic neurons. AREAS COVERED This narrative review gives an overview of the pathophysiology and approaches to managing patients with residual sleepiness. The authors explore different targeted strategies aimed at improving selection of appropriate pharmacotherapy. EXPERT OPINION Wake-stimulant medications (modafinil and armodafinil) have demonstrated efficacy in reducing sleepiness in adequately treated OSA. The recent FDA approval of pitolisant and solriamfetol complements the use of modafinil by substituting for direct sympathomimetic agents. The distinctive pharmacologic profile and mode of action of each of these agents offer the opportunity of a personalized approach to the management of this disorder. Further studies should be conducted on the long-term effect of these agents alone or in combination on brain structural and functional changes.
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Affiliation(s)
- Ali A El-Solh
- Research and Development, The Veterans Affairs Western New York Healthcare System, Buffalo, NY, USA.,Department of Epidemiology and Environmental Health; School of Public Health and Health Professions, University at Buffalo, USA
| | - Avantika Rudraraju
- Research and Development, The Veterans Affairs Western New York Healthcare System, Buffalo, NY, USA.,Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, USA
| | - Divij Pasrija
- Research and Development, The Veterans Affairs Western New York Healthcare System, Buffalo, NY, USA.,Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, USA
| | - Hoang Bui
- Research and Development, The Veterans Affairs Western New York Healthcare System, Buffalo, NY, USA
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8
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Epstein M, Musa T, Chiu S, Costanzo J, Dunne C, Cerrone F, Capone R. Use of the WatchPAT to detect occult residual sleep-disordered breathing in patients on CPAP for obstructive sleep apnea. J Clin Sleep Med 2020; 16:1073-1080. [PMID: 32118574 DOI: 10.5664/jcsm.8406] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
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 sleep-disordered 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 CPAP AHI. 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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Affiliation(s)
- Matthew Epstein
- Atlantic Health Sleep Centers, Livingston, New Jersey.,Atlantic Health System, Morristown, New Jersey.,New Jersey Medical School, Newark, New Jersey
| | - Tariq Musa
- Atlantic Health System, Morristown, New Jersey
| | | | | | - Christine Dunne
- Atlantic Health Sleep Centers, Livingston, New Jersey.,Atlantic Health System, Morristown, New Jersey
| | - Federico Cerrone
- Atlantic Health Sleep Centers, Livingston, New Jersey.,Atlantic Health System, Morristown, New Jersey
| | - Robert Capone
- Atlantic Health Sleep Centers, Livingston, New Jersey.,Atlantic Health System, Morristown, New Jersey
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Liu S, Rétory Y, Sagniez A, Hardy S, Cottin F, Roisman G, Petitjean M. New physiological bench test reproducing nocturnal breathing pattern of patients with sleep disordered breathing. PLoS One 2019; 14:e0225766. [PMID: 31805102 PMCID: PMC6894807 DOI: 10.1371/journal.pone.0225766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 11/12/2019] [Indexed: 11/18/2022] Open
Abstract
Previous studies have shown that Automatic Positive Airway Pressure devices display different behaviors when connected to a bench using theoretical respiratory cycle scripts. However, these scripts are limited and do not simulate physiological behavior during the night. Our aim was to develop a physiological bench that is able to simulate patient breathing airflow by integrating polygraph data. We developed an algorithm analyzing polygraph data and transformed this information into digital inputs required by the bench hardware to reproduce a patient breathing profile on bench. The inputs are respectively the simulated respiratory muscular effort pressure input for an artificial lung and the sealed chamber pressure to regulate the Starling resistor. We did simulations on our bench for a total of 8 hours and 59 minutes for a breathing profile from the demonstration recording of a Nox T3 Sleep Monitor. The simulation performance results showed that in terms of relative peak-valley amplitude of each breathing cycle, simulated bench airflow was biased by only 1.48% ± 6.80% compared to estimated polygraph nasal airflow for a total of 6,479 breathing cycles. For total respiratory cycle time, the average bias ± one standard deviation was 0.000 ± 0.288 seconds. For patient apnea events, our bench simulation had a sensitivity of 84.7% and a positive predictive value equal to 90.3%, considering 149 apneas detected both in polygraph nasal simulated bench airflows. Our new physiological bench would allow personalizing APAP device selection to each patient by taking into account individual characteristics of a sleep breathing profile.
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Affiliation(s)
- Shuo Liu
- Centre EXPLOR, Air Liquide Healthcare, Gentilly, France
- CIAMS, Univ. Paris-Sud, Université Paris-Saclay, Orsay Cedex, France
- CIAMS, Université d’Orléans, Orléans, France
| | - Yann Rétory
- Centre EXPLOR, Air Liquide Healthcare, Gentilly, France
| | | | | | - François Cottin
- CIAMS, Univ. Paris-Sud, Université Paris-Saclay, Orsay Cedex, France
- CIAMS, Université d’Orléans, Orléans, France
| | - Gabriel Roisman
- Centre du Sommeil, Service d’Explorations Fonctionnelles Multidisciplinaires, Hôpital Antoine Béclère, Assistance Publique-Hôpitaux de Paris, Clamart, France
| | - Michel Petitjean
- CIAMS, Univ. Paris-Sud, Université Paris-Saclay, Orsay Cedex, France
- CIAMS, Université d’Orléans, Orléans, France
- Centre du Sommeil, Service d’Explorations Fonctionnelles Multidisciplinaires, Hôpital Antoine Béclère, Assistance Publique-Hôpitaux de Paris, Clamart, France
- * E-mail:
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10
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Extended evaluation of the efficacy of a proactive forced oscillation technique-based auto-CPAP algorithm. Sleep Breath 2019; 24:825-833. [DOI: 10.1007/s11325-019-01901-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 07/05/2019] [Accepted: 07/12/2019] [Indexed: 11/26/2022]
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11
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Hadigal S, Sharma S, Wagner MH, Ryals S, Berry RB. Sudden Improvement in PAP Download Indices Without Treatment Change. J Clin Sleep Med 2019; 15:791-793. [PMID: 31053218 DOI: 10.5664/jcsm.7780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 02/19/2019] [Indexed: 11/13/2022]
Affiliation(s)
- Susheela Hadigal
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida, Gainesville, Florida
| | - Surina Sharma
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida, Gainesville, Florida
| | - Mary H Wagner
- Division of Pulmonary and Sleep Medicine, Department of Pediatrics, University of Florida, Gainesville, Florida
| | - Scott Ryals
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida, Gainesville, Florida
| | - Richard B Berry
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida, Gainesville, Florida
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12
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Blanco M, Ernst G, Salvado A, Borsini E. Impact of Mask Type on the Effectiveness of and Adherence to Unattended Home-Based CPAP Titration. SLEEP DISORDERS 2019; 2019:4592462. [PMID: 31019811 PMCID: PMC6452566 DOI: 10.1155/2019/4592462] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 01/28/2019] [Indexed: 11/24/2022]
Abstract
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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Affiliation(s)
- Magalí Blanco
- Sleep and Ventilation Unit, Hospital Británico de Buenos Aires, Argentina
| | - Glenda Ernst
- Center for Respiratory Medicine, Hospital Británico de Buenos Aires, Argentina
| | - Alejandro Salvado
- Center for Respiratory Medicine, Hospital Británico de Buenos Aires, Argentina
| | - Eduardo Borsini
- Sleep and Ventilation Unit, Hospital Británico de Buenos Aires, Argentina
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Patil SP, Ayappa IA, Caples SM, Kimoff RJ, Patel SR, Harrod CG. Treatment of Adult Obstructive Sleep Apnea With Positive Airway Pressure: An American Academy of Sleep Medicine Systematic Review, Meta-Analysis, and GRADE Assessment. J Clin Sleep Med 2019; 15:301-334. [PMID: 30736888 DOI: 10.5664/jcsm.7638] [Citation(s) in RCA: 330] [Impact Index Per Article: 66.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 01/14/2019] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The purpose of this systematic review is to provide supporting evidence for the clinical practice guideline for the treatment of obstructive sleep apnea (OSA) in adults using positive airway pressure (PAP). METHODS The American Academy of Sleep Medicine commissioned a task force of experts in sleep medicine. A systematic review was conducted to identify studies that compared the use of PAP with no treatment as well as studies that compared different PAP modalities. Meta-analyses were performed to determine the clinical significance of using PAP in several modalities (ie, continuous PAP, auto-adjusting PAP, and bilevel PAP), to treat OSA in adults. In addition, meta-analyses were performed to determine the clinical significance of using an in-laboratory versus ambulatory strategy for the initiation of PAP, educational and behavioral interventions, telemonitoring, humidification, different mask interfaces, and flexible or modified pressure profile PAP in conjunction with PAP to treat OSA in adults. Finally, the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) process was used to assess the evidence for making recommendations. RESULTS The literature search resulted in 336 studies that met inclusion criteria; 184 studies provided data suitable for meta-analyses. The data demonstrated that PAP compared to no treatment results in a clinically significant reduction in disease severity, sleepiness, blood pressure, and motor vehicle accidents, and improvement in sleep-related quality of life in adults with OSA. In addition, the initiation of PAP in the home demonstrated equivalent effects on patient outcomes when compared to an in-laboratory titration approach. The data also demonstrated that the use of auto-adjusting or bilevel PAP did not result in clinically significant differences in patient outcomes compared with standard continuous PAP. Furthermore, data demonstrated a clinically significant improvement in PAP adherence with the use of educational, behavioral, troubleshooting, and telemonitoring interventions. Systematic reviews for specific PAP delivery method were also performed and suggested that nasal interfaces compared to oronasal interfaces have improved adherence and slightly greater reductions in OSA severity, heated humidification compared to no humidification reduces some continuous PAP-related side effects, and pressure profile PAP did not result in clinically significant differences in patient outcomes compared with standard continuous PAP.
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Affiliation(s)
| | - Indu A Ayappa
- Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - R Joh Kimoff
- McGill University Health Centre, Montreal, Quebec, Canada
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Zhu K, Farré R, Katz I, Hardy S, Escourrou P. Mimicking a flow-limited human upper airway using a collapsible tube: relationships between flow patterns and pressures in a respiratory model. J Appl Physiol (1985) 2018; 125:605-614. [PMID: 29672227 DOI: 10.1152/japplphysiol.00877.2017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The upper airway (UA) in humans is commonly modeled as a Starling resistor. However, negative effort dependence (NED) observed in some patients with obstructive sleep apnea (OSA) contradicts predictions based on the Starling resistor model in which inspiratory flow is independent of inspiratory driving pressure when flow is limited. In a respiratory bench model consisting of a collapsible tube and an active lung model (ASL5000), inspiratory flow characteristics were investigated in relation to upstream, downstream, and extra-luminal pressures (denoted as Pus, Pds, and Pout, respectively) by varying inspiratory effort (muscle pressure) from -1 to -20 cmH2O in the active lung. Pus was provided by a constant airway pressure device and varied from 4 to 20 cmH2O, and Pout was set at 10 and 15 cmH2O. Upstream resistance at onset of flow limitation and critical transmural pressure (Ptm) corresponding to opening of the UA were found to be independent of Pus, Pds, and Pout. With fixed Ptm, when Pds fell below a specific value (Pds'), inspiratory peak flow became constant and independent of Pds. NED plateau flow patterns at mid-inspiration (V̇n) were produced within the current bench setting when Pds fell below Pds'. V̇n was proportional to Pds, and the slope (ΔV̇n/ΔPds) increased linearly with Ptm. Ptm and Pds were the two final independent determinants of inspiratory flow. Our bench model closely mimics a flow-limited human UA, and the findings have implications for OSA treatment and research, especially for bench-testing auto-titrating devices in a more physiological way. NEW & NOTEWORTHY A respiratory model consisting of a collapsible tube was used to mimic a flow-limited human upper airway. Flow-limited breathing patterns including negative effort dependence were produced. Transmural and downstream pressures acting on the tube are the two independent determinants of the resulting inspiratory flow during flow limitation. The findings have implications for obstructive sleep apnea treatment and research, especially for bench-testing auto-titrating devices in a more physiological way.
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Affiliation(s)
- Kaixian Zhu
- Centre Explor, Air Liquide Healthcare, Gentilly, France
| | - Ramon Farré
- Unit of Biophysics and Bioengineering, Faculty of Medicine and Health Sciences, University of Barcelona-Institut Investigacions Biomediques August Pi Sunyer , Barcelona , Spain.,Centro de Investigacion Biomedica en Red (CIBER) de Enfermedades Respiratorias, Madrid, Spain
| | - Ira Katz
- Medical Research & Development, Air Liquide Santé International, Centre de Recherche Paris-Saclay, Les Loges-en-Josas, France.,Department of Mechanical Engineering, Lafayette College , Easton, Pennsylvania
| | | | - Pierre Escourrou
- Department of Physiology, Université Paris-Saclay, AP-HP Hôpital Antoine-Béclère, Clamart, France
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Zhu K, Rabec C, Gonzalez-Bermejo J, Hardy S, Aouf S, Escourrou P, Roisman G. Combined effects of leaks, respiratory system properties and upper airway patency on the performance of home ventilators: a bench study. BMC Pulm Med 2017; 17:145. [PMID: 29157220 PMCID: PMC5697337 DOI: 10.1186/s12890-017-0487-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 11/10/2017] [Indexed: 12/14/2022] Open
Abstract
Background Combined effects of leaks, mechanical property of respiratory system and upper airway (UA) patency on patient-ventilator synchrony (PVA) and the level of clinically “tolerable” leaks are not well established in home ventilators. Methods We comparatively assessed on a bench model, the highest leak level tolerated without inducing significant asynchrony (“critical leak”) in three home ventilators (Astral 150, Trilogy 100 and Vivo 60; noted as A150, T100 and V60 respectively) subjected to three simulated diseased respiratory conditions: chronic obstructive pulmonary disease (COPD), obesity hypoventilation (OHS) and neuromuscular disorders (NMD), with both open and closed UA. Also, total leak values in the device reports were compared to the bench-measured values. Results With open UA, all ventilators were able to avoid asynchrony up to a 30 L/min leak and even to 55 L/min in some cases. UA closure and respiratory diseases especially OHS influenced PVA. With closed UA, the critical leak of A150 and T100 remained higher than 55 L/min in COPD and OHS, while for V60 decreased to 41 and 33 L/min respectively. In NMD with closed UA, only T100 reached a high critical leak of 69 L/min. Besides, inspiratory trigger sensitivity change was often necessary to avoid PVA. Conclusions Home ventilators were able to avoid PVA in high-level leak conditions. However, asynchrony appeared in cases of abnormal mechanical properties of respiratory system or closed UA. In case of closed UA, the EPAP should be adjusted prior to the inspiratory trigger. Trial registration Not applicable. Electronic supplementary material The online version of this article (10.1186/s12890-017-0487-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kaixian Zhu
- Centre Explor, Air Liquide Healthcare, 28 rue d'Arcueil, 94250, Gentilly, France.
| | - Claudio Rabec
- Service de Pneumologie et Soins Intensifs Respiratoires, Centre Hospitalier Universitaire Dijon Bourgogne, 14 rue Paul Gaffarel, F-21079, Dijon, France
| | - Jésus Gonzalez-Bermejo
- Sorbonne Universités, UPMC Univ Paris 6, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France.,Service de Pneumologie et Réanimation Médicale (Département "R3S"), AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, F-75013, Paris, France
| | - Sébastien Hardy
- Centre Explor, Air Liquide Healthcare, 28 rue d'Arcueil, 94250, Gentilly, France
| | - Sami Aouf
- Centre Explor, Air Liquide Healthcare, 28 rue d'Arcueil, 94250, Gentilly, France
| | - Pierre Escourrou
- Service des Explorations Fonctionnelles Multidisciplinaires, AP-HP, Hôpital Antoine-Béclère, 157 rue de la Porte de Trivaux, 92140, Clamart, France
| | - Gabriel Roisman
- Service des Explorations Fonctionnelles Multidisciplinaires, AP-HP, Hôpital Antoine-Béclère, 157 rue de la Porte de Trivaux, 92140, Clamart, France
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Oldenburg O, Fox H, Wellmann B, Thiem U, Horstkotte D, Bitter T. Automatic positive airway pressure for treatment of obstructive sleep apnea in heart failure. SOMNOLOGIE 2017. [DOI: 10.1007/s11818-017-0124-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Abstract
Sleep-related breathing disorders include obstructive sleep apnea (OSA), central sleep apnea, sleep-related hypoventilation, and sleep-related hypoxemia. Excessive daytime sleepiness (EDS) is frequently reported by patients with OSA but is not invariably present. The efficacy of positive airway pressure therapy in improving EDS is well established for OSA, but effectiveness is limited by suboptimal adherence. Non-OSA causes of sleepiness should be identified and treated before initiating pharmacotherapy for persistent sleepiness despite adequately treated OSA. Further research on the identification of factors that promote EDS in the setting of OSA is needed to aid in the development of better treatment options.
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Affiliation(s)
- Ken He
- Division of General Internal Medicine, University of Washington, Seattle, WA 98195, USA; Hospital and Sleep Medicine Sections, VA Puget Sound Health Care System, S-111-Pulm, 1660 South Columbian Way, Seattle, WA 98108, USA
| | - Vishesh K Kapur
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, WA 98104, USA
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Zhu K, Aouf S, Roisman G, Escourrou P. Pressure-Relief Features of Fixed and Autotitrating Continuous Positive Airway Pressure May Impair Their Efficacy: Evaluation with a Respiratory Bench Model. J Clin Sleep Med 2017; 12:385-92. [PMID: 26564383 DOI: 10.5664/jcsm.5590] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 10/06/2015] [Indexed: 01/19/2023]
Abstract
STUDY OBJECTIVES Pressure-relief features are aimed at improving the patient's comfort during continuous positive airway pressure (CPAP) treatment for obstructive sleep apnea. The objective of this study was to determine the effect of these therapy features on fixed CPAP and autotitrating CPAP (APAP) treatment efficacy. METHODS Seven pressure-relief features applied by three CPAP devices were included in our study (Remstar Auto: C-Flex 3, C-Flex+ 3, A-Flex 3, P-Flex; AirSense 10: EPR 3; Prisma 20A: SoftPAP 2 and 3). In fixed CPAP, the devices were subjected to a 10-min bench-simulated obstructive apnea sequence (initial apnea-hypopnea index, AHI = 60/h) with and without pressure-relief features. In APAP, the sequence was lengthened to 4.2 h (initial AHI = 58.6/h). The residual AHI and mean/median pressure were compared with and without pressure-relief features. RESULTS Compared to conventional CPAP, where pressure was adjusted to be just sufficient to control the simulated obstructive events, C-Flex+ 3, P-Flex, and EPR 3 failed to normalize the breathing flow and did not reduce the AHI. The mean pressures with the three features, respectively, were 1.8, 2.6, and 2.6 cmH2O lower than the conventional CPAP. Compared to conventional APAP, similar levels of control were observed with pressure-relief features, apart from P-Flex where the delivered mean pressure was lower and residual AHI greater. The device-reported mean/median pressures in APAP with A-Flex 3, P-Flex, EPR 3, and SoftPAP 3 were higher than that measured on the bench. CONCLUSIONS Pressure-relief features may attenuate CPAP efficacy if not adjusted for at the time of their introduction. In clinical practice, efficacy can be ensured by increasing the therapeutic pressure delivered by fixed CPAP or by enabling the pressure-relief features prior to initial pressure titration. Device-reported pressures in APAP devices with pressure relief activated may overstate delivered pressures.
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Affiliation(s)
- Kaixian Zhu
- Air Liquide Healthcare, Gentilly, France.,Sleep Disorders Center, AP-HP Antoine-Béclère Hospital, Clamart, France.,Faculty of Pharmacy, Paris-Sud University, Châtenay-Malabry, France
| | - Sami Aouf
- Air Liquide Healthcare, Gentilly, France
| | - Gabriel Roisman
- Sleep Disorders Center, AP-HP Antoine-Béclère Hospital, Clamart, France
| | - Pierre Escourrou
- Sleep Disorders Center, AP-HP Antoine-Béclère Hospital, Clamart, France.,Faculty of Pharmacy, Paris-Sud University, Châtenay-Malabry, France
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Ebben MR. The science of CPAP. CURRENT PULMONOLOGY REPORTS 2016. [DOI: 10.1007/s13665-016-0146-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Farré R, Navajas D, Montserrat JM. Technology for noninvasive mechanical ventilation: looking into the black box. ERJ Open Res 2016; 2:00004-2016. [PMID: 27730162 PMCID: PMC5005145 DOI: 10.1183/23120541.00004-2016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 01/17/2016] [Indexed: 11/21/2022] Open
Abstract
Current devices for providing noninvasive respiratory support contain sensors and built-in intelligence for automatically modifying ventilation according to the patient's needs. These devices, including automatic continuous positive airway pressure devices and noninvasive ventilators, are technologically complex and offer a considerable number of different modes of ventilation and setting options, the details of which are sometimes difficult to capture by the user. Therefore, better predicting and interpreting the actual performance of these ventilation devices in clinical application requires understanding their functioning principles and assessing their performance under well controlled bench test conditions with simulated patients. This concise review presents an updated perspective of the theoretical basis of intelligent continuous positive airway pressure and noninvasive ventilation devices, and of the tools available for assessing how these devices respond under specific ventilation phenotypes in patients requiring breathing support. Current devices for intelligent noninvasive ventilation should be tested to better understand clinical performance http://ow.ly/XAS6Z
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Affiliation(s)
- Ramon Farré
- Unitat Biofísica i Bioenginyeria, Facultat de Medicina, Universitat de Barcelona, Barcelona, Spain; CIBER Enfermedades Respiratorias, Madrid, Spain; Institut d'Investigacions Biomèdiques August Pi Sunyer, Barcelona, Spain
| | - Daniel Navajas
- Unitat Biofísica i Bioenginyeria, Facultat de Medicina, Universitat de Barcelona, Barcelona, Spain; CIBER Enfermedades Respiratorias, Madrid, Spain; Institut de Bioenginyeria de Catalunya, Barcelona, Spain
| | - Josep M Montserrat
- CIBER Enfermedades Respiratorias, Madrid, Spain; Institut d'Investigacions Biomèdiques August Pi Sunyer, Barcelona, Spain; Sleep Lab, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
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Thomas RJ. Positive pressure therapy induced harm – non-linear, adaptive and maladaptive responses. Sleep Med 2015; 16:1582-3. [DOI: 10.1016/j.sleep.2015.07.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 07/23/2015] [Indexed: 10/23/2022]
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Johnson KG, Johnson DC. Treatment of sleep-disordered breathing with positive airway pressure devices: technology update. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2015; 8:425-37. [PMID: 26604837 PMCID: PMC4629962 DOI: 10.2147/mder.s70062] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Many types of positive airway pressure (PAP) devices are used to treat sleep-disordered breathing including obstructive sleep apnea, central sleep apnea, and sleep-related hypoventilation. These include continuous PAP, autoadjusting CPAP, bilevel PAP, adaptive servoventilation, and volume-assured pressure support. Noninvasive PAP has significant leak by design, which these devices adjust for in different manners. Algorithms to provide pressure, detect events, and respond to events vary greatly between the types of devices, and vary among the same category between companies and different models by the same company. Many devices include features designed to improve effectiveness and patient comfort. Data collection systems can track compliance, pressure, leak, and efficacy. Understanding how each device works allows the clinician to better select the best device and settings for a given patient. This paper reviews PAP devices, including their algorithms, settings, and features.
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