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Appendix 9 Pgs. 7-8
K Zhu, S Aouf, G Roisman et al. CPAP Treatment Efficacy with Pressure-Relief Features
activation of pressure relief. Thus, the treatment efficacy can be ensured by increasing the device pressure in fixed CPAP or by enhancing the full range of pressure in APAP. In the latter case, a well-functioning autotitration algorithm is indispens- able. In addition, the pressure-relief features allocated for ther - apy should be enabled prior to the titration process. It should also be noted that the device-reported pressure in pressure- relief APAP is not comparable to that without pressure relief. CONCLUS I ONS Pressure-relief features may lead to attenuated CPAP treat- ment efficacy depending on the applied settings and the device. In clinical practice, the therapy efficacy can be ensured by in - creasing the therapeutic pressure or by enabling the pressure- relief features prior to the manual or auto titration process. The pressures in the pressure-relief APAP device reports are not comparable to that of conventional APAPs. ABBREV I AT I ONS AHI, apnea-hypopnea index AI, apnea index ANOVA, analysis of variance APAP, autotitrating continuous positive airway pressure
9. Nilius G, Happel A, Domanski U, Ruhle K-H. Pressure-relief continuous positive airway pressure vs constant continuous positive airway pressure: a comparison of efficacy and compliance. Chest 2006;130:1018–24. 10. Mulgrew AT, Cheema R, Fleetham J, Ryan CF, Ayas NT. Efficacy and patient satisfaction with autoadjusting CPAP with variable expiratory pressure vs standard CPAP: a two-night randomized crossover trial. Sleep Breath 2006;11:31–7. 11. Kakkar RK, Berry RB. Positive airway pressure treatment for obstructive sleep apnea. Chest 2007;132:1057–72. 12. Marshall NS, Neill AM, Campbell AJ. Randomised trial of compliance with flexible (C-Flex) and standard continuous positive airway pressure for severe obstructive sleep apnea. Sleep Breath 2008;12:393–6. 13. Pépin J-L, Muir J-F, Gentina T, et al. Pressure reduction during exhalation in sleep apnea patients treated by continuous positive airway pressure. Chest 2009;136:490–7. 14. Bakker J, Campbell A, Neill A. Randomized controlled trial comparing flexible and continuous positive airway pressure delivery: effects on compliance, objective and subjective sleepiness and vigilance. Sleep 2010;33:523–9. 15. Chihara Y, Tsuboi T, Hitomi T, et al. Flexible positive airway pressure improves treatment adherence compared with auto-adjusting PAP. Sleep 2013;36:229–36. 16. Brown LK. Achieving adherence to positive airway pressure therapy: modifying pressure and the holy grail. Chest 2011;139:1266–8. 17. Bakker JP, Marshall NS. Flexible pressure delivery modification of continuous positive airway pressure for obstructive sleep apnea does not improve compliance with therapy: systematic review and meta-analysis. Chest 2011;139:1322–30. 18. Farré R, Montserrat JM, Rigau J, Trepat X, Pinto P, Navajas D. Response of automatic continuous positive airway pressure devices to different sleep breathing patterns: a bench study. Am J Respir Crit Care Med 2002;166:469–73. 19. Abdenbi F, Chambille B, Escourrou P. Bench testing of auto-adjusting positive airway pressure devices. Eur Respir J 2004;24:649–58. 20. Coller D, Stanley D, Parthasarathy S. Effect of air leak on the performance of auto-PAP devices: a bench study. Sleep Breath 2005;9:167–75. 21. Lofaso F, Desmarais G, Leroux K, et al. Bench evaluation of flow limitation detection by automated continuous positive airway pressure devices. Chest 2006;130:343–9. 22. Rigau J, Montserrat JM, Wöhrle H, et al. Bench model to simulate upper airway obstruction for analyzing automatic continuous positive airway pressure devices. Chest 2006;130:350–61. 23. Hirose M, Honda J, Sato E, et al. Bench study of auto-CPAP devices using a collapsible upper airway model with upstream resistance. Respir Physiol Neurobiol 2008;162:48–54. 24. Netzel T, Hein H, Hein Y. APAP device technology and correlation with patient compliance. Somnologie 2014;18:113–20. 25. Zhu K, Roisman G, Aouf S, Escourrou P. All APAPs are not equivalent for the treatment of sleep-disordered breathing: a bench evaluation of eleven commercially available devices. J Clin Sleep Med 2015;11:725–34. 26. Iber C, Ancoli-Israel S, Chesson A, Quan S, for the American Academy of Sleep Medicine. The AASM manual for the scoring of sleep and associated events: rules, terminology and technical specifications, 1st ed. Westchester, IL: American Academy of Sleep Medicine, 2007. 27. 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;9:861–71. 28. Morrell MJ, Arabi Y, Zahn B, Badr MS. Progressive retropalatal narrowing preceding obstructive apnea. Am J Respir Crit Care Med 1998;158:1974–81. 29. Sanders MH, Kern N. Obstructive sleep apnea treated by independently adjusted inspiratory and expiratory positive airway pressures via nasal mask. physiologic and clinical implications. Chest 1990;98:317–24. 30. Hertegonne KB, Rombaut B, Houtmeyers P, Van Maele G, Pevernagie DA. Titration efficacy of two auto-adjustable continuous positive airway pressure devices using different flow limitation-based algorithms. Respir Int Rev Thorac Dis 2008;75:48–54.
CPAP, continuous positive airway pressure EPAP, expiratory positive airway pressure IPAP, inspiratory positive airway pressure OSA, obstructive sleep apnea Pm , mask pressure SDB, sleep disordered breathing V’, mask airflow ΔV’, peak-to-peak flow amplitude
REFERENCE 1. Shapiro GK, Shapiro CM. Factors that influence CPAP adherence: an overview. Sleep Breath 2010;14:323–35. 2. Weaver TE, Grunstein RR. Adherence to Continuous Positive Airway Pressure Therapy. Proc Am Thorac Soc 2008;5:173–8. 3. Wickwire EM, Lettieri CJ, Cairns AA, Collop NA. Maximizing positive airway pressure adherence in adults: a common-sense approach. Chest 2013;144:680–93. 4. Smith I, Lasserson TJ. Pressure modification for improving usage of continuous positive airway pressure machines in adults with obstructive sleep apnoea. Cochrane Database Syst Rev 2009:CD003531. 5. Marcus CL, Beck SE, Traylor J, et al. Randomized, double-blind clinical trial of two different modes of positive airway pressure therapy on adherence and efficacy in children. J Clin Sleep Med 2012;8:37–42. 6. Blau A, Minx M, Peter JG, et al. Auto bi-level pressure relief-PAP is as effective as CPAP in OSA patients–a pilot study. Sleep Breath 2011;16:773–9. 7. Powell ED, Gay PC, Ojile JM, Litinski M, Malhotra A. A pilot study assessing adherence to auto-bilevel following a poor initial encounter with CPAP. J Clin Sleep Med 2012;8:43–7. 8. Aloia MS, Stanchina M, Arnedt JT, Malhotra A, Millman RP. Treatment adherence and outcomes in flexible vs standard continuous positive airway pressure therapy. Chest 2005;127:2085–93.
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