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(Chest. 2006;130:343-349.)
© 2006 American College of Chest Physicians

Bench Evaluation of Flow Limitation Detection by Automated Continuous Positive Airway Pressure Devices*

Frédéric Lofaso, MD, PhD; Gilbert Desmarais, PhD; Karl Leroux; Vincent Zalc; Redouane Fodil, PhD; Daniel Isabey, PhD and Bruno Louis, PhD

* From National Institute for Health and Medical Research (Institut National de la Santé et de la Recherche Médicale), Unit 651 (Drs. Fodil, Isabey, and Louis), Henri Mondor Teaching Hospital, Créteil; Assistance Publique des Hôpìtaux de Paris (Drs. Lofaso and Desmarais and Mr. Zalc), Raymond Poincaré Teaching Hospital, Physiology-Functional Testing, and Technological Innovations Centre, Garches, France; and People with Polio and Disabilities (Association d’Entraide des Polios et Handicapés) [Mr. Leroux], Puteaux, France.

Correspondence to: Frédéric Lofaso, MD, PhD, Service de Physiologie-Explorations Fonctionnelles, Hôpital Raymond Poincaré, 92380 Garches, France; e-mail: f.lofaso{at}rpc.ap-hop-paris.fr

Abstract

Study objective: Automatic continuous positive airway pressure (CPAP) devices that adjust the pressure delivered to the patient are now available to treat sleep-disordered breathing. Sophisticated auto-CPAP devices can detect and correct flattened inspiratory flow contours (FIFCs) associated with subtle upper airway obstruction. However, evaluations of their performance are made difficult by differences across patients and devices. We performed a bench study of five commercially available auto-CPAP devices using a breath waveform simulator to evaluate sensitivity for detecting flattened inspiratory flow.

Design: Five degrees of FIFC were simulated. In addition, normal and abnormal flow contours from patients published in the literature were evaluated.

Measurements and results: One device showed autotriggering leading to CPAP increases, and another device varied the CPAP level independently from the presence of an FIFC. The three remaining devices differed regarding the detection of FIFCs and the means used to increase CPAP.

Conclusion: Based on the characteristics of each patient, physicians must choose among devices with different thresholds of FIFC detection and different pressure responses to detection. Therefore, physicians need details on the algorithms used in auto-CPAP devices. Manufacturers should supply detailed algorithms.

Key Words: continuous positive airway pressure • flow limitation • obstructive sleep apnea




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L. K. Brown
Autotitrating CPAP: How Shall We Judge Safety and Efficacy of a "Black Box"?
Chest, August 1, 2006; 130(2): 312 - 314.
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