Leak Profile Inspection During Nasal Continuous Positive Airway Pressure

Baltzan, Marcel A.; Dabrusin, Richard; García-Asensi, Alfonso; Sully, Jennie-Laure; Parenteau, Maryse; Tansimat, Germaine; Kassissia, Ibrahim; Wolkove, Norman

doi:10.4187/respcare.00977

Cited by 12 publications

(6 citation statements)

References 25 publications

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“…Nasal mask use is also associated with fewer residual apneas, fewer leaks, and lower effective pressure [26]. However, in the current study, mask change did not result in significant changes in residual apneas and leaks, but more leaks were associated with poorer 6-month compliance, as previously demonstrated [27]. In clinical practice, this means that regardless of the initial type of mask (nasal or oro-nasal), technicians and clinicians should focus on controlling leaks from the start of treatment.…”

Section: Discussionsupporting

confidence: 55%

Pressure adjustment is the most useful intervention for improving compliance in telemonitored patients treated with CPAP in the first 6 months of treatment

Carlier

Bruyneel²,

Bruyneel

2021

Sleep Breath

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Purpose Telemonitoring (TMg) for patients treated with continuous positive airway pressure (CPAP) is now routine care in some sleep labs. The purpose of the present study was to identify technical interventions associated with improved CPAP compliance in a real-life cohort of newly telemonitored patients with obstructive sleep apnea (OSA) during the first 6 months of treatment. Methods All patients with moderate-to-severe OSA (apnea-hypopnea index (AHI) ≥ 15/h) who were newly treated with CPAP were included in the study and telemonitored. A group educational session was scheduled after 1 month. Technical interventions were performed at the patient's request and during scheduled visits and the impact of each intervention on CPAP therapy compliance was collected. Results Between May 2018 and Dec 2019, 349 patients newly diagnosed with OSA were hospitalized in the sleep lab for CPAP titration and 212 patients were included (mean age 54.6 ± 13.1 years, mean BMI 31.7 ± 5.8 kg/m 2 , mean AHI 42.8 ± 22.0). TMg acceptance rate was 87%. Mean 6-month compliance was 275 ± 154 min, 13% stopped CPAP, and 17% were non-compliant. Correlations were observed between BMI (r = 0.15, p = 0.029), median and 95th percentile leaks (r = −0.23 and −0.18, p = 0.016 and 0.002), and CPAP compliance.During follow-up, 92 interventions were required, mainly for mask change (n = 80). Pressure modification (n = 16) was the only intervention that increased CPAP use > 30 min/night, p = 0.021. Conclusion Pressure modification was the only adaptation that significantly increased CPAP compliance during the first 6 months. Remote TMg allows providing daily, accurate, and immediate feedback that could help clinicians to confirm that the CPAP treatment is effective.

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Section: Discussionsupporting

confidence: 55%

Pressure adjustment is the most useful intervention for improving compliance in telemonitored patients treated with CPAP in the first 6 months of treatment

Carlier

Bruyneel²,

Bruyneel

2021

Sleep Breath

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“…17,18 In adults, barriers to CPAP adherence also include lower socioeconomic status (SES); technical issues; lack of support; and both negative psychological predispositions and effects of the treatment. [20][21][22][23][24][25] Factors supporting CPAP usage in the adult population include higher SES; greater burden of social, emotional, and physical problems; positive attitudes toward healthcare and treatment; presence of supports; fear of the consequences of the illness; and experiencing improvement with treatment. 22,23,[26][27][28][29][30][31][32][33][34] Similar to the pediatric population, an early pattern of adherence to CPAP therapy in adults was a significant predictor of subsequent adherence.…”

mentioning

confidence: 99%

Facilitators and Barriers to Noninvasive Ventilation Adherence in Youth with Nocturnal Hypoventilation Secondary to Obesity or Neuromuscular Disease

Ennis

Rohde

Chaput

et al. 2015

Journal of Clinical Sleep Medicine

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“…Valentin et al demonstrated that device-reported leaks during the first week of treatment were slightly associated with lower adherence to CPAP therapy at 5 weeks of treatment (a threshold-adjusted leak-level of 4.9 L/min/cm H 2 O was associated with a sensitivity of 0.62 and specificity of 0.65 for discriminating adherent and non-adherent patients) [6]. Baltzan et al reported (using a manual score of device-reported leaks with a cut-off of 20 l/min of unintentional leaks and patterns of continuous leaks or serrated leaks) that the highest quartile of percentage time in continuous leaks may be linked to adherence during the first 3 months of treatment (but the relationship did not reach statistical significance) [7]. The aetiology of leaks is also an important issue, and more attention should be given to mouth leaks, as recommended by the 2013 ATS statement [3].…”

Section: Discussionmentioning

confidence: 99%

Is the 2013 American Thoracic Society CPAP-tracking system algorithm useful for managing non-adherence in long-term CPAP-treated patients?

et al. 2019

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Background Whereas telemedicine usage is growing, the only clinical algorithm for Continuous Positive Airway Pressure (CPAP) adherence management is that stipulated by the 2013 American Thoracic Society (ATS). The capacity of the latter to predict non-adherence in long-term CPAP-treated patients has not been validated. Methods Patients from the prospective real-life InterfaceVent study (NCT03013283, study conducted in an adult cohort undergoing at least 3 months of CPAP) and eligible for ATS algorithm usage were analysed. The residual device Apnea–Hypopnea-Index (AHIflow) and High Large Leak (HLL) thresholds proposed in the ATS algorithm were evaluated for predicting adherence (i.e. AHIflow > 10/h, HLLs 95th > 24 L/min for ResMed® devices and ResMed® nasal mask, HLLs 95th > 36 l/min for ResMed® devices and ResMed® oronasal masks, HLLs > 1 h for Philips® devices and HHLs > 60 l/min for Fisher & Paykel® devices). Adherence was defined according to the 2013 ATS algorithm (i.e. CPAP use > 4 h/j for at least 70% of days). Results 650/1484 patients eligible for ATS algorithm usage were analysed (15.38% non-adherent, 74% male with a median (IQ25–75) age of 68 (61–77) years, a body mass index of 30.8 (27.7–34.5) kg/m2, an initial AHI of 39 (31–55) events/h, and CPAP-treatment-duration of 5.1 (2.2–7.8) years). Logistic regression analysis demonstrated no significant relationship between the ATS proposed AHIflow or HLL thresholds and non-adherence. Complementary ROC curve analysis failed to determine satisfactory AHIflow and HLL thresholds. Conclusion When managing non-adherence in long-term CPAP-treated patients, our data do not validate absolute AHIflow or HLL thresholds in general. Trial registration The INTERFACE-VENT study is registered on ClinicalTrials.gov (Identifier: study (NCT03013283).

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Leak Profile Inspection During Nasal Continuous Positive Airway Pressure

Cited by 12 publications

References 25 publications

Pressure adjustment is the most useful intervention for improving compliance in telemonitored patients treated with CPAP in the first 6 months of treatment

Pressure adjustment is the most useful intervention for improving compliance in telemonitored patients treated with CPAP in the first 6 months of treatment

Facilitators and Barriers to Noninvasive Ventilation Adherence in Youth with Nocturnal Hypoventilation Secondary to Obesity or Neuromuscular Disease

Is the 2013 American Thoracic Society CPAP-tracking system algorithm useful for managing non-adherence in long-term CPAP-treated patients?

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