Nasal continuous positive airway pressure treatment: current realities and future.
ABSTRACT Nasal continuous positive airway pressure (CPAP) is a highly effective treatment for obstructive sleep apnea syndrome. The apnea/hypopnea index (AHI) is reduced 10-fold, but the patient dropout rate is up to 30%, and usage is typically < 5 hours per night. Titration, designed to make the best trade-off between effectiveness and side effects, is expensive. Autotitrating devices make this trade-off on a minute-by-minute basis, potentially reducing mean pressure delivery, reducing side effects, and increasing compliance. The aim of this study was to test the effectiveness of the AutoSet self-adjusting nasal CPAP system (ResMed, Sydney, Australia) in eliminating obstructive events and normalizing the arousal index. Forty-five subjects (41 males and 4 females with AHI) values of > 20/hour were recruited, with written informed consent. Subjects slept for a diagnostic night, followed by a treatment night, in the laboratory, using the AutoSet system with full polysomnographic monitoring of respiratory and sleep variables. Arousals were scored using ASDA criteria. Hypopneas were scored when there was a 50% reduction in ventilation for > 10 seconds, associated with a 4% drop in oxygen saturation. For comparison, the ASDA arousal index in 16 normal subjects (without nasal CPAP) is provided. Results are given as mean +/- standard error of the mean. AHI was reduced from 55 +/- 3 to 1.5 +/- 0.35 events/hour (p < 0.0001). The arousal index was reduced from 65 +/- 3 to 18 +/- 2 events/hour (p < 0.0001), identical to the value in the 16 healthy normal subjects. There was a 158% +/- 21% increase in slow-wave sleep (p = 0.01) and a 186% +/- 27% increase in rapid eye movement sleep (p = 0.013). The AutoSet self-adjusting nasal CPAP system adequately treats obstructive sleep apnea syndrome on the first night under laboratory conditions.
SourceAvailable from: Kaixian Zhu[Show abstract] [Hide abstract]
ABSTRACT: Adaptive servoventilation devices are marketed to overcome sleep disordered breathing with apneas and hypopneas of both central and obstructive mechanisms often experienced by patients with chronic heart failure. The clinical efficacy of these devices is still questioned. This study challenged the detection and treatment capabilities of the three commercially available adaptive servoventilation devices in response to sleep disordered breathing events reproduced on an innovative bench test. The bench test consisted of a computer-controlled piston and a Starling resistor. The three devices were subjected to a flow sequence composed of central and obstructive apneas and hypopneas including Cheyne-Stokes respiration derived from a patient. The responses of the devices were separately evaluated with the maximum and the clinical settings (titrated expiratory positive airway pressure), and the detected events were compared to the bench-scored values. The three devices responded similarly to central events, by increasing pressure support to raise airflow. All central apneas were eliminated, whereas hypopneas remained. The three devices responded differently to the obstructive events with the maximum settings. These obstructive events could be normalized with clinical settings. The residual events of all the devices were scored lower than bench test values with the maximum settings, but were in agreement with the clinical settings. However, their mechanisms were misclassified. The tested devices reacted as expected to the disordered breathing events, but not sufficiently to normalize the breathing flow. The device-scored results should be used with caution to judge efficacy, as their validity depends upon the initial settings. Zhu K; Kharboutly H; Ma J; Bouzit M; Escourrou P. Bench test evaluation of adaptive servoventilation devices for sleep apnea treatment. J Clin Sleep Med 2013;9(9):861-871.Journal of clinical sleep medicine: JCSM: official publication of the American Academy of Sleep Medicine 09/2013; 9(9):861-71. DOI:10.5664/jcsm.2982 · 2.83 Impact Factor
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ABSTRACT: Background and objectiveNocturnal application of continuous positive airway pressure (CPAP) is the standard treatment for patients with obstructive sleep apnoea (OSA). Determination of the therapeutic pressure (CPAP titration) is usually performed by a technician in the sleep laboratory during attended polysomnography. One possible alternative to manual titration is automated titration. Indeed, during the last 15 years, devices have been developed that deliver autoadjustable CPAP (A-CPAP). The aim of the present study was to compare the titration effectiveness of two A-CPAP devices using different flow-based algorithms in patients with OSA. Methods This is a randomized study; 79 subjects underwent two consecutive unattended home A-CPAP titration nights with two different devices (Autoset Resmed; Remstar Auto Respironics); during the third and the fourth night, patients underwent portable monitoring in the sleep laboratory during fixed CPAP at the A-CPAP recommended pressure. ResultsBland Altman plots showed good agreement between the recommended median and maximal pressure levels obtained with the two devices. A significant improvement was observed in all the sleep parameters by both A-CPAP machines to a similar degree. Conclusions It was observed that the two A-CPAP devices using different algorithms are equally effective in initial titration of CPAP.Respirology 08/2013; 18(6). DOI:10.1111/resp.12098 · 3.50 Impact Factor
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ABSTRACT: Zusammenfassung Trotz der Effektivitt der Therapie des obstruktiven Schlafapnoe-Syndroms (OSAS) mit konstantem nasalen Positivdruck (nCPAP) wenden bis zu 30% der Patienten die Behandlung nicht an. Es wurden daher automatische nCPAP-Systeme entwickelt, die den Druck senken und so Beeintrchtigungen der Patienten mindern sollen. Die forcierte Oszillationstechnik (FOT) ist ein sensitives Verfahren zur Erfassung der Widerstnde der oberen Atemwege, auch bei OSAS. Ziel dieser Studie war es, die Effektivitt eines automatischen nCPAP-Systems auf der Basis von FOT hinsichtlich polysomnographischer Parameter und des notwendigen Druckprofils zu untersuchen. Nach diagnostischer Polysomnographie (PSG) wurden 21 Patienten zunchst einer manuellen CPAP-Titration zur Findung eines Druckes zur konstanten nCPAP-Therapie und anschlieend einer Therapienacht mit APAPfotunterzogen. Im Vergleich zum Ausgangswert nahmen der Apnoe-Hypopnoe-Index (AHI [Diagnose] 25,221,9/h, AHI [APAPfot] 3,03,4/h, pfot] 21,711,3/h, pfot] 3,03,7/h, pfot] 20,85,7% TST, pfotim Vergleich zum manuell titrierten konstanten nCPAP deutlich gesenkt werden (manuell titrierter Druck 8,61,8 mbar, P mean [APAPfot] 5,41,6 mbar, pfoteine effektive Therapie des OSAS bei deutlich verringertem Druck erlaubt.Somnologie - Schlafforschung und Schlafmedizin 10/1999; 3(5):264-269. DOI:10.1007/s11818-999-0034-3