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Research ArticleOriginal Research

Reversal of PAP Failure With the REPAP Protocol

Barry Krakow, Victor A Ulibarri, Natalia D McIver, Carli Yonemoto, Alyssa Tidler, Jessica Obando, Michelle R Foley-Shea, Jonathan Ornelas and Spencer Dawson
Respiratory Care April 2017, 62 (4) 396-408; DOI: https://doi.org/10.4187/respcare.05032
Barry Krakow
Sleep and Human Health Institute, Albuquerque, New Mexico.Maimonides Sleep Arts and Sciences, Albuquerque, New Mexico.Los Alamos Medical Center, Los Alamos, New Mexico.
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  • For correspondence: bkrakow@sleeptreatment.com
Victor A Ulibarri
Sleep and Human Health Institute, Albuquerque, New Mexico.Maimonides Sleep Arts and Sciences, Albuquerque, New Mexico.
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Natalia D McIver
Sleep and Human Health Institute, Albuquerque, New Mexico.Maimonides Sleep Arts and Sciences, Albuquerque, New Mexico.
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Carli Yonemoto
Maimonides Sleep Arts and Sciences, Albuquerque, New Mexico.
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Alyssa Tidler
Maimonides Sleep Arts and Sciences, Albuquerque, New Mexico.
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Jessica Obando
Maimonides Sleep Arts and Sciences, Albuquerque, New Mexico.
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Michelle R Foley-Shea
Maimonides Sleep Arts and Sciences, Albuquerque, New Mexico.
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Jonathan Ornelas
Maimonides Sleep Arts and Sciences, Albuquerque, New Mexico.
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Spencer Dawson
Department of Psychology, University of Arizona, Tucson, Arizona.
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    Fig. 1.

    Flow chart. PAP = positive airway pressure, PSG = polysomnography.

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    Fig. 2.

    Flow chart showing positive airway pressure (PAP) therapy use during three distinct time periods. Initial = period immediately after the first or only re-titration; Transitional = period where subjects either used PAP but had no further re-titrations, used PAP and had one or more additional re-titrations, or were not using PAP but completed one or more additional re-titrations; Final = user status as of chart review end date. Final users (sum of all dark gray boxes) and Final non-users (sum of all dashed line boxes). *Of the 77 final non-users, 58 re-initiated PAP therapy either after initial or repeat re-titration studies but once again failed for various reasons (mask issues: 9, pressure intolerance: 9, lost to follow-up: 9, general adaptation problems: 7, money/insurance: 6, nasal congestion/allergy exacerbation: 4, no appreciable benefit: 4, claustrophobia: 3, physical side effects: 2, believed PAP was no longer needed: 2, focus on other health issues: 1). The remaining 19 subjects never re-initiated PAP. Of all 77 final PAP non-users, 21 pursued oral appliance therapy, and 9 elected to have surgery.

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    Fig. 3.

    Indications for recommended ≥2 re-titrations in subjects completing multiple re-titrations (n = 158). SDB = sleep-disordered breathing.

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Respiratory Care: 62 (4)
Respiratory Care
Vol. 62, Issue 4
1 Apr 2017
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Reversal of PAP Failure With the REPAP Protocol
Barry Krakow, Victor A Ulibarri, Natalia D McIver, Carli Yonemoto, Alyssa Tidler, Jessica Obando, Michelle R Foley-Shea, Jonathan Ornelas, Spencer Dawson
Respiratory Care Apr 2017, 62 (4) 396-408; DOI: 10.4187/respcare.05032

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Reversal of PAP Failure With the REPAP Protocol
Barry Krakow, Victor A Ulibarri, Natalia D McIver, Carli Yonemoto, Alyssa Tidler, Jessica Obando, Michelle R Foley-Shea, Jonathan Ornelas, Spencer Dawson
Respiratory Care Apr 2017, 62 (4) 396-408; DOI: 10.4187/respcare.05032
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Keywords

  • PAP failure
  • obstructive sleep apnea
  • upper airway resistance
  • respiratory effort-related arousals
  • expiratory pressure intolerance
  • bi-level
  • auto-bi-level
  • adaptive servo-ventilation

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