S A N T È • LÖW E N S T E I N S L E E P T H E R A PY D E V I C E S
minute volume, & obstruction graph upon download & review of the detailed signal data. The presence of sleep disordered breathing is categorised within the detailed data into ‘epochs’ of 2-minute duration. There are 3 levels of epochs according to degree of severity of obstruction: eFL (epoch flow limitation), eMO (epoch moderate obstruction) & eSO (epoch severe obstruction). In response to 2-minute epoch’s, pressure adjustment is provided through a balanced, logical & consistent structure* which deviates the extent of pressure adjustment provided depending on where the current pressure is at on the Pmin to Pmax scale & severity of the obstruction. Since Pmin to Pmax is tailored to an individual’s needs, the pressure is regulated in a way which avoids applying uncomfortable or sub-optimum pressure levels. The option of ‘Standard’ & ‘Dynamic’ algorithm provides a whole further dimension to how proactive the treatment is (refer to the following sub- heading).
*Refer to Appendix 2 page 9 onwards
the same, although ‘Dynamic’ will yield a pressure increase immediately upon 6 breaths of snoring. The key difference is that ‘Dynamic’ will continue to treat epochs of flow limitations throughout the first three quartiles of pressure range. This setting suits patients with UARS (Upper Airway Respiratory Syndrome), & helps to further optimise the numerical results of users who have become more accustomed to APAP therapy.
Dynamic & Standard Algorithm Prisma devices offer 2 algorithm settings called ‘Standard’ & ‘Dynamic.’* ‘Standard’ algorithm goal is to maximise patient acceptance through lowest possible pressures. With ‘Standard,’ respiratory events such as repeated snoring within a 2-minute epoch & RERA’s are categorised & treated effectively & efficiently according to the treatment structure at the end of the 2-minute epoch. Obstructive Apnoea’s & Hypopnea’s are identified & treated immediately up to 2 times within a 2-minute epoch. However, epochs of flow limitations are only treated within the first quartile of pressure range. This setting suits new APAP users & patients not tolerant of fluctuating or high pressure. ‘Dynamic’ algorithm goal is designed to treat partial obstructions with greater sensitivity & more proactively before these turn into more severe obstructions. The treatment to all respiratory events is much
*Refer to Appendix 2 page 9 onwards
Stability of Pressure Adjustment The challenge of the APAP algorithm is to provide stable, therapeutically effective & lowest possible pressures. • Fast pressure decreases cause anew serious obstructions & arousals. • Fast or extreme pressure increase in response to obstructions can cause arousal, lead to high mean pressures or high-pressure variability (more fast decreases). • Inadequate increase to severe
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