Auto-CPAP: an effective and low-cost procedure in the management of OSAS?

Lévy, Patrick; Pépin, Jean‐Louis

doi:10.1183/09031936.98.12040753

Cited by 18 publications

(9 citation statements)

References 16 publications

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“…If the preference data are explained at least in part by the prolonged periods of low pressure, patients with the greatest variability in pressure would be the best candidates for such a device. This has already been suggested by us (11) and others, but never demonstrated. It would be helpful to evaluate the benefit of APAP in patients who comply poorly.…”

Section: What Can We Expect?supporting

confidence: 58%

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Autoadjusting Continuous Positive Airway Pressure

Lévy¹,

Pépin²

2001

Am J Respir Crit Care Med

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Section: What Can We Expect?supporting

confidence: 58%

“…Costs might be reduced by using APAP to perform titration, which could be done either in the ward or at home (12), and then used for 1 or 2 wk at home with systematic clinical follow-up (2,11). This would allow selection of patients with the highest variability on the basis of more than a single test night.…”

Section: What Can We Expect?mentioning

confidence: 99%

Autoadjusting Continuous Positive Airway Pressure

Lévy¹,

Pépin²

2001

Am J Respir Crit Care Med

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“…Typically, after a 2-week period of use, the information stored in these devices-reflecting the pressure levels achieved-is downloaded, and the effective pressure determined as the 95th percentile of the pressures administered [5,18]. In bench studies, however, investigators have shown that different auto-PAP devices achieved different pressure levels when subjected to the same events of OSA [13,14].…”

Section: Determination Of Effective Pressurementioning

confidence: 99%

Effect of air leak on the performance of auto-PAP devices: a bench study

2005

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Automatic positive airway pressure (auto-PAP) devices, used in the treatment of patients with obstructive sleep apnea (OSA), may not function optimally in the presence of an air leak. We set out to determine the magnitude of air leak that prevents auto-PAP devices from responding to respiratory events of OSA in a bench model. We simulated apnea, flow limitation, obstructive hypopnea, nonobstructive hypopnea, and snoring events of OSA with an artificial airway and a loudspeaker in a bench model connected to a commercially available auto-PAP device. Four auto-PAP devices were tested, but two of the "older-generation" devices (Tranquility and Virtuoso) did not respond to events of OSA that involved changes in flow contour; hence, we studied the effects of air leak and humidifier in the two "newer-generation" auto-PAP devices only (GoodKnight 418P, Autoset-T). When the air leak was progressively increased from baseline levels recommended by the manufacturer to levels seen clinically--5 to 7, 10, and 30 l/min--the GoodKnight 418P decreased pressure response by 56% (5.6+/-1.8 cm H(2)O, p=0.04). The pressure response of the Autoset-T, however, did not change from baseline during similar levels of air leak. The GoodKnight performed appropriately when the air leak was within 20 l/min, but the corresponding value for the Autoset was higher at 50 l/min. For both devices combined, air leak caused the pressure to drop between the device and the airway: 2.8+/-0.3 cm H(2)O at 30 l/min of air leak (p<0.001). Air leaks cause auto-PAP devices to underestimate the pressure required to treat events of OSA and to overestimate the pressure delivered at the upper airway. Physicians should be aware of performance limitations of auto-PAP devices in the presence of an air leak.

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“…Another consideration is that costs might be reduced by using ACPAP to perform titration, which could be done either in wards or at home, and then used for 1 or 2 weeks at home with systematic clinical follow-up [4,5]. Another method proposed is to calculate therapeutic pressure by predictive equations.…”

Section: Introductionmentioning

confidence: 99%