Effect of air leak on the performance of auto-PAP devices: a bench study |
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Authors: | Dale?Coller Dawn?Stanley Email author" target="_blank">Sairam?ParthasarathyEmail author |
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Institution: | (1) Metropolitan Hospital, Grand Rapids, MI, USA;(2) Critical Care and Pulmonary Consultants, Aurora, CO, USA;(3) Section of Pulmonary and Critical Care Medicine, Southern Arizona VA Healthcare System, Mail Stop 1-111A, 3601 South Sixth Avenue, Tucson, AZ 85723, USA |
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Abstract: | 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 H2O, 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
H2O 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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Keywords: | Sleep apnea Algorithms Equipment design Positive-pressure respiration Respiration |
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