PT  - JOURNAL ARTICLE
AU  - Lucas Fasquel
AU  - Pouyan Yazdani
AU  - Cindy Zaugg
AU  - Alyssia Barras
AU  - Jean-Bernard Michotte
AU  - Nils Correvon
AU  - Olivier Contal
TI  - Impact of Unintentional Air Leaks on Automatic Positive Airway Pressure Device Performance in Simulated Sleep Apnea Events
AID  - 10.4187/respcare.10065
DP  - 2022 Nov 08
TA  - Respiratory Care
PG  - respcare.10065
4099  - http://rc.rcjournal.com/content/early/2022/11/08/respcare.10065.short
4100  - http://rc.rcjournal.com/content/early/2022/11/08/respcare.10065.full
AB  - BACKGROUND: Positive airway pressure (PAP) is the accepted standard treatment for obstructive sleep apnea. In the last decades, automatic PAP (APAP) adjustment modes have been increasingly used. Pressure auto adjustment offers better comfort to the patient and represents a valuable help for the clinician to provide optimal treatment. However, device performance differs among manufacturers. Furthermore, the success of the therapy relies greatly on unintentional air leak (UAL) level for many reasons, hence the importance to investigate the performance of the most common devices. The aim of this study was to compare the performance of 3 APAP devices from the most common manufacturers in specific conditions (obstructive sleep apnea, central sleep apnea, hypopnea), with and without UAL.METHODS: This was a bench test study. Performance tests were conducted on a breathing simulator using a Starling resistor, representing the upper airways, and an adjustable UAL valve. Three APAP devices (AirSense 10, DreamStation, and Prisma 20A) were tested in different scenarios.RESULTS: Without UAL, performance of the 3 devices was similar to existing literature. However, performance was altered with the addition of UAL in some scenario. The AirSense 10 was not able to respond correctly to obstructive apnea (intraclass correlation coefficient [ICC] 0.021, P = .61) and hypopnea (ICC 0.059, P = .26). Prisma 20A lowest performance was seen during simulated obstructive apnea (ICC 0.708, P < .001). DreamStation lowest performance was seen during simulated hypopnea events (ICC 0.755, P < .001).CONCLUSIONS: All 3 APAP devices reacted differently to the added UAL. Performance was altered with some devices, which could affect the therapy success in patients with sleep apnea syndrome. The variability of performance of some APAP devices with UAL should make clinicians evaluate their use in a home setting.