Impact of Unintentional Air Leaks on Automatic Positive Airway Pressure Device Performance in Simulated Sleep Apnea Events release_khgjhdsgxrbsddirexkb3civ2e

by Lucas Fasquel, Pouyan Yazdani, Cindy Zaugg, Alyssia Barras, Jean-Bernard Michotte, Nils Correvon, Olivier Contal

Published in Respiratory care by Daedalus Enterprises.

2022   Volume 68, Issue 1, respcare.10065

Abstract

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. 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. 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 = .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). 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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