Journal des troubles du sommeil et de la thérapie
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Reducing Inspiratory Positive Airway Pressure (IPAP) to Treat Obstructive Sleep Apnea Provides Equivalent Therapy, Improves Comfort, and Reduces Unintentional Leak

Robert J. Farney*, Bernard Hete, David P. White, Krishna M. Sundar, Wilson D. Lannom, Molly Ann Pucket, William H. Noah

Background: Continuous positive airway pressure is the most effective therapy for Obstructive Sleep Apnea (OSA) but long-term adherence remains a challenge. Reducing Inspiratory Positive Airway Pressure (IPAP) below Expiratory Positive Airway Pressure (EPAP) may improve comfort and potentially compliance. The goal of this quality control evaluation was to determine if reducing IPAP below EPAP using the V-Com™ device maintained efficacy as assessed by the residual Apnea Hypopnea Index (AHI), P90%/P95% pressure requirements, usage time and leak.

Methods: We reduced IPAP below EPAP by adding non-compensated resistance (V-Com™) to the AutoPAP (APAP) circuit in patients with uncomplicated OSA. Four consecutive nights of data were collected with and without the V̇- Com™. Objective parameters obtained from the APAP devices over these 8 days included AHI, usage time, leak, pressure settings, and P90%/P95% pressures.

Results: There were 62 (34 male) patients in phase 1 (17 React Health Luna II, 22 Phillips-Respironics DreamStation 2, 23 ResMed AirSense 10 or 11 devices) and 40 (22 male) patients in phase 2 (ResMed AirSense 10 or 11 devices). The mean (SD) AHI decreased from 2.15 (2.35)/hour without the V-Com™ compared to 1.79 (1.74)/hour with the V-Com™ and 1.21 (1.06) to 0.97 (0.82)/hour in phases 1 and 2 respectively.

Conclusions: Our results indicate that reducing IPAP below EPAP with the V-Com™ device during APAP use provided equivalent therapy and did not interfere with the algorithms of the APAP devices. In addition, the V-Com™ device decreased the AHI, reduced leak and increased usage time without adversely affecting P90%/P95%pressures.