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Obstructive pressure peak: a new method for differentiation of obstructive and central apneas under auto-CPAP therapy

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Abstract

Purpose

Auto-CPAP devices (APAP) are controlled, e.g., by the respiratory flow and pressure to adjust the treatment pressure to the variable obstruction in sleep apnea syndromes. By obstruction of the upper airway during inspiration, a pressure difference between the lower airways and the mask can be measured. In case of an opening of the pharynx at the end of the obstruction, the pressure decreases immediately. This brief negative pressure, the so-called obstructive pressure peak (OPP) can be used to identify obstruction or open airways with the algorithm of an APAP device. Useless pressure increases, e.g., after central apneas without obstruction may be avoided. We therefore investigated the association of the OPP signal with respiratory events during APAP therapy.

Methods

In this pilot study, 13 patients with obstructive sleep apnea syndrome were evaluated. Attended automatic CPAP titration (SOMNObalance, Fa Weinmann Hamburg/Germany) was performed. The OPP signal was recorded synchronously in parallel with the polysomnographic data. If the OPP signal was within a time range of ±5 s of the resumption of normal breathing, it was assigned to the event.

Results

A total of 480 sleep-related breathing disorders events were studied. The most common were the mixed apneas associated with more than 90% of all cases with an OPP signal, followed by obstructive sleep apneas (66.7%) and central apneas (38%). The difference in OPP frequency distribution between central apneas and obstructive apneas was significant with p < 0.001.

Conclusions

The analysis of the pressure characteristics of APAP treatment with the registration of OPP allows a further differentiation in obstructed and not obstructed upper airways.

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References

  1. Randerath W, Parys K, Lehmann D, Sanner B, Feldmeyer F, Rühle K-H (2000) Self-adjusting continuous positive airway pressure therapy based on the measurement of impedance. Respiration 67:272–279

    Article  PubMed  CAS  Google Scholar 

  2. Morgenthaler TI, Aurora RN, Brown T, Zak R, Alessi C, Boehlecke B, Chesson AL Jr, Friedman L, Kapur V, Maganti R, Owens J, Pancer J, Swick TJ, Standards of Practice Committee of the AASM, American Academy of Sleep Medicine (2008) Practice parameters for the use of autotitrating continuous positive airway pressure devices for titrating pressures and treating adult patients with obstructive sleep apnea syndrome: an update for 2007. An American Academy of Sleep Medicine report. Sleep 31:141–147

    PubMed  Google Scholar 

  3. Massie CA, McArdle N, Hart RW, Schmidt-Nowara WW, Lankford A, Hudgel DW, Gordon N, Douglas NJ (2003) Comparison between automatic and fixed positive airway pressure therapy in the home. Am J Respir Crit Care Med 167:20–23

    Article  PubMed  Google Scholar 

  4. Randerath WJ, Schraeder O, Galetke W, Feldmeyer F, Rühle KH (2001) Autoadjusting CPAP therapy based on impedance efficacy, compliance and acceptance. Am J Respir Crit Care Med 163:652–657

    PubMed  CAS  Google Scholar 

  5. Montserrat JM, Farré R, Navajas D (2001) New technologies to detect static and dynamic upper airway obstruction during sleep. Sleep Breath 5:193–206

    Article  PubMed  CAS  Google Scholar 

  6. Condos R, Norman RG, Krishnasamy I, Peduzzi N, Goldring RM, Rapoport DM (1994) Flow limitation as a noninvasive assessment of residual upper-airway resistance during continuous positive airway pressure therapy of obstructive sleep apnea. Am J Respir Crit Care Med 150:475–480

    PubMed  CAS  Google Scholar 

  7. Ayappa I, Norman RG, Hosselet JJ, Gruenke RA, Walsleben JA, Rapoport DM (1998) Relative occurrence of flow limitation and snoring during continuous positive airway pressure titration. Chest 114:685–690

    Article  PubMed  CAS  Google Scholar 

  8. Morgenstern C, Schwaibold M, Randerath WJ, Bolz A, Jané R (2010) An invasive and a noninvasive approach for the automatic differentiation of obstructive and central hypopneas. IEEE Trans Biomed Eng 57(8):1927–1936

    Article  PubMed  Google Scholar 

  9. Farré R, Rigau J, Montserrat JM, Ballester E, Navajas D (2001) Evaluation of a simplified oscillation technique for assessing airway obstruction in sleep apnoea. Eur Respir J 17:456–461

    Article  PubMed  Google Scholar 

  10. Pilz K, Thalhofer S, Meissner P, Dorow P (2000) Improvement of CPAP therapy by a self-adjusting system. Sleep Breath 4:169–172

    Article  PubMed  Google Scholar 

  11. Rühle KH, Schlenker E, Randerath W (1997) Upper airway resistance syndrome. Respiration 64(Suppl 1):29–34

    PubMed  Google Scholar 

  12. Rechtschaffen A, Kales A (1968) A manual of standardized terminology, techniques and scoring system for sleep stages of human subjects. Brain Information Service/ Brain Research Institute, University of California, Los Angeles

    Google Scholar 

  13. ASDA Task Force (1992) EEG arousals; scoring rules and examples. Sleep 15:173–184

    Google Scholar 

  14. Iber C, Ancoli-Israel S, Chesson A, Quan S, American Academy of Sleep Medicine (2007) The AASM manual for the scoring of sleep and associated events: rules, terminology and technical specifications, 1st edn. American Academy of Sleep Medicine, Westchester

    Google Scholar 

  15. Badr MS, Toiber F, Skatrud JB, Dempsey J (1995) Pharyngeal narrowing/occlusion during central sleep apnea. J Appl Physiol 78:1806–1815

    PubMed  CAS  Google Scholar 

  16. Badia JR, Farré R, Montserrat JM, Ballester E, Hernandez L, Rotger M, Rodriguez-Roisin R, Navajas D (1998) Forced oscillation technique for the evaluation of severe sleep apnoea/hypopnoea syndrome: a pilot study. Eur Respir J 11:1128–1134

    Article  PubMed  CAS  Google Scholar 

  17. Galetke W, Stieglitz S, Anduleit N, Kenter M, Kühnel J, Osagie-Paech R, Richter K, Randerath W (2009) Evaluation of a new automatic CPAP algorithm in the treatment of obstructive sleep apnoea syndrome. Pneumologie 63:261–265

    Article  PubMed  CAS  Google Scholar 

  18. Rigau J, Montserrat JM, Wöhrle H, Plattner D, Schwaibold M, Navajas D, Farré R (2006) Bench model to simulate upper airway obstruction for analyzing automatic continuous positive airway pressure devices. Chest 130:350–361

    Article  PubMed  Google Scholar 

  19. Farré R, Montserrat JM, Rigau J, Trepat X, Pinto P, Navajas D (2002) Response of automatic continuous positive airway pressure devices to different sleep breathing patterns: a bench study. Am J Respir Crit Care Med 166:469–473

    Article  PubMed  Google Scholar 

  20. Rühle KH, Karweina D, Domanski U, Nilius G (2009) Characteristics of auto-CPAP devices during the simulation of sleep-related breathing flow patterns. Pneumologie 63:390–398

    Article  PubMed  Google Scholar 

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Conflicts of interest

K.H. Rühle and G. Nilius received funding from Weinmann, Fisher & Paykel Healthcare, Heinen and Löwenstein, ResMed, and TNI. This money went to scientific projects of the clinic, including methodology in this work.

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Authors and Affiliations

  1. Department of Pneumology, HELIOS Clinic Ambrock, Ambrockerweg 60, 58091, Hagen, Germany

    K. H. Ruhle, U. Domanski & G. Nilius

  2. University of Witten-Herdecke, North Rhine-Westphalia, Germany

    K. H. Ruhle & G. Nilius

Authors
  1. K. H. Ruhle
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  2. U. Domanski
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  3. G. Nilius
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Correspondence to K. H. Ruhle.

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Ruhle, K.H., Domanski, U. & Nilius, G. Obstructive pressure peak: a new method for differentiation of obstructive and central apneas under auto-CPAP therapy. Sleep Breath 17, 111–115 (2013). https://doi.org/10.1007/s11325-012-0657-7

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  • DOI: https://doi.org/10.1007/s11325-012-0657-7

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