Abstract
Bench testing is a useful method to characterize the response of different automatic positive airway pressure (APAP) devices under well-controlled conditions. However, previous models did not consider the diversity of obstructive sleep apnea (OSA) patients’ characteristics and phenotypes. The objective of this proof-of-concept study was to design a new bench test for realistically simulating an OSA patient’s night, and to implement a one-night example of a typical female phenotype for comparing responses to several currently-available APAP devices. We developed a novel approach aimed at replicating a typical night of sleep which includes different disturbed breathing events, disease severities, sleep/wake phases, body postures and respiratory artefacts. The simulated female OSA patient example that we implemented included periods of wake, light sleep and deep sleep with positional changes and was connected to ten different APAP devices. Flow and pressure readings were recorded; each device was tested twice. The new approach for simulating female OSA patients effectively combined a wide variety of disturbed breathing patterns to mimic the response of a predefined patient type. There were marked differences in response between devices; only three were able to overcome flow limitation to normalize breathing, and only five devices were associated with a residual apnea-hypopnea index of <5/h. In conclusion, bench tests can be designed to simulate specific patient characteristics, and typical stages of sleep, body position, and wake. Each APAP device behaved differently when exposed to this controlled model of a female OSA patient, and should lead to further understanding of OSA treatment.
Highlights
Obstructive sleep apnea (OSA) is a prevalent breathing disorder and is considered a major public health issue, affecting 5–15% of the general population and increasing with both body mass index and age [1,2]
There was considerable variation among devices, with respect to the mean and maximum nasal pressures applied, and the ability to overcome obstructive events and flow limitation, The residual apnea-hypopnea index (AHI) was calculated as the number of residual obstructive events per hour and the residual flow limitation was measured as the portion of the test in minutes that the simulated patient remained on flow limitation
We successfully developed and carried out a proof-of-concept test of a novel optimized bench model adaptable to simulate different sleep-disordered breathing (SDB) patterns found in OSA, including periods of wake, periods representing different sleep stages and phases of more or less severe SDB events
Summary
Obstructive sleep apnea (OSA) is a prevalent breathing disorder and is considered a major public health issue, affecting 5–15% of the general population and increasing with both body mass index and age (up to at least 60–65 years) [1,2]. New OSA Patient Simulator for Testing PAP Devices collection and analysis, decision to publish, or preparation of the manuscript. The specific roles of these authors are articulated in the 'author contributions' section
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