Sleep and Breathing

, Volume 9, Issue 4, pp 167–175

Effect of air leak on the performance of auto-PAP devices: a bench study

Original Article

DOI: 10.1007/s11325-005-0032-z

Cite this article as:
Coller, D., Stanley, D. & Parthasarathy, S. Sleep Breath (2005) 9: 167. doi:10.1007/s11325-005-0032-z

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.

Keywords

Sleep apnea Algorithms Equipment design Positive-pressure respiration Respiration 

Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  • Dale Coller
    • 1
  • Dawn Stanley
    • 2
  • Sairam Parthasarathy
    • 2
    • 3
  1. 1.Metropolitan HospitalGrand RapidsUSA
  2. 2.Critical Care and Pulmonary ConsultantsAuroraUSA
  3. 3.Section of Pulmonary and Critical Care MedicineSouthern Arizona VA Healthcare SystemTucsonUSA

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