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Inspiratory flow limitation: Comparison of the C-flex system versus conventional therapy—A pilot study

Inspiratorische Flusslimitationen: Vergleich des C-Flex-Systems gegen eine konventionelle CPAP-Therapie-eine Pilotstudie

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Summary

Question of the study

Compliance with nasal continuous positive airway pressure (nCPAP) treatment may be reduced due to difficulties when exhaling against a positive pressure. A recently introduced CPAP system therefore lowers the expiratory pressure proportional to the patient's airflow. To evaluate the theoretical concern that this might induce, flow limitations during inspiration, we measured the occurrence of flow limitation during sleep.

Patients and methods

Eight subjects with treated obstructive sleep apnoea were studied with polysomnography including respiratory flow and oesophageal pressure measurement. Conventional CPAP and three settings of the new system were applied in a randomised order during both NREM and REM sleep. Two approaches for measuring inspiratory flow limitation were used: oesophageal pressure and respiratory resistance.

Results

Using the oesophageal pressure criterion, 3.5% of breaths during CPAP mode were flow limited as compared to 1.4% during the new mode. Flow limitations using the novel criterion of respiratory resistance, we counted 13.6% of flow-limited breaths during CPAP mode and 10.1% during the new mode. Equivalence testing confirmed equivalence between the novel system and CPAP.

Conclusions

The results confirm that there is no increase in the number of flow limitations during the new mode as compared to CPAP.

Zusammenfassung

Fragestellung

Manche Patienten klagen darüber, dass es für sie problematisch ist, gegen einen kontinuierlichen positiven Druck bei der CPAP-Therapie auszuatmen. Möglicherweise reduziert diese Problematik die Compliance der Patienten. Ein kürzlich eingeführtes CPAP-System senkt während der Exspiration den Druck proportional zum vom Patienten generierten Atemfluss ab. Ein Kritikpunkt dieser exspiratorischen Druckabsenkung ist, dass sie eventuell inspiratorische Flusslimitationen induzieren kann. Um diesen Aspekt zu klären, untersuchten wir das Auftreten von inspiratorischen Flusslimitationen während des Schlafs.

Patienten und Methodik

An dieser Studie nahmen 8 Patienten mit mittels CPAP-Therapie behandelten schlafbezogenen Atmungsstörungen teil. Alle 8 Patienten unterzogen wir einer kompletten Polysomnographie inklusive inspiratorischer Flussmessung und Ösophagusdruckmessung. Eine konventionelle CPAP-Therapie und alle 3 Modi der neuen Therapie mit exspiratorischer Druckabsenkung wurden in randomisierter Reihenfolge während NREM und REM-Schlaf appliziert. Zur Erfassung von inspiratorischen, Flusslimitationen wurden 2 verschiedene Verfahren genutzt: der Ösophagusdruck und die Messung der respiratorischen Resistance.

Ergebnisse

Mit dem Ösophagusdruckkriterium wurden 3,5% der Atemzüge unter konventioneller CPAP-Therapie und 1,4% unter Therapie mit exspiratorischer Druckabsenkung als flusslimitiert gewertet. Sowohl im NREM- als auch im REM-Schlaf war die Zahl der Flusslimitationen unter Therapie mit exspiratorischer Druckabsenkung signifikant reduziert. Erfasst mit der Methode der respiratorischen Resistance war der Anteil flusslimitierter Atemzüge höher: 13,6% während konventioneller CPAP-Therapie und 10,1% während der Therapie mit exspiratorischer Druckabsenkung. Die Äquivalenztestung bestätigte Äquivalenz zwischen der Therepie mit exspiratorischer Druckabsenkung und der konventionellen CPAP-Therapie.

Schlussfolgerung

Diese Ergebnisse zeigen, dass eine exspiratorische Druckabsenkung im getesteten System nicht zum Auftreten zusätzlicher inspiratorischer Flusslimiationen führt.

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Authors and Affiliations

  1. Sleep Laboratory, Respiratory Medicine, Dept. of Internal Medicine, Philipps-University, Baldingerstr. 1, 35033, Marburg, Germany

    Andreas Jerrentrup, Sebastian Canisius, Karl Kesper, Thomas Ploch, Thomas Penzel, Sven Rostig, Jörg Heitmann, Claus Vogelmeier & Heinrich Becker

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  1. Andreas Jerrentrup
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  2. Sebastian Canisius
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  3. Karl Kesper
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  4. Thomas Ploch
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  5. Thomas Penzel
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  8. Claus Vogelmeier
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  9. Heinrich Becker
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Correspondence to Andreas Jerrentrup.

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Jerrentrup, A., Canisius, S., Kesper, K. et al. Inspiratory flow limitation: Comparison of the C-flex system versus conventional therapy—A pilot study. Somnologie 10, 61–66 (2006). https://doi.org/10.1007/j.1439-054X.2006.00087.x

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