Protocolo para evaluar una CPAP automática. Valoración de la utilidad del Autoset-T para determinar la presión de Cpap óptima en el síndrome de apnea-hipopnea del sueño

Abstract

Given the high prevalence of sleep apnea/hypopnea syndrome (SAHS) and great demand for conventional polysomnography (PSG) and long waiting lists, alternative means for diagnosing SAHS and titrating continuous positive airway pressure (CPAP) are needed. Automatic CPAP may play a role in meeting the last objective, not only for treatment but also for suggesting the optimum CPAP setting. a) To define a protocol to assess the functioning of an automatic CPAP device by means of a mechanical model; b) to determine the behavior of automatically adjusted CPAP during PSG; c) to define the usefulness of automatic CPAP for indicating optimal CPAP pressure for patients with SAHS; d) to evaluate the efficacy of the automatically indicated pressure setting against conventional PSG. Four protocols were carried out using the Autoset-T (AT) device. 1. Apneas, hypopneas, flow limitation, snoring and normal flow were simulated in a laboratory using a mechanical model in order to check AT functioning. 2. The behavior of the automatically adjusted CPAP was observed in real time during PSG in 12 patients with severe SAHS. 3. The agreement of CPAP titrated with the AT and with PSG was checked in a group of 39 patients with SAHS. 4. The efficacy of the CPAP pressure recommended by the AT was checked by PSG in a group of 14 patients with SAHS. With the AT, CPAP increased rapidly in response to apneas or snoring in the mechanical model and during conventional PSG; it took only a mean 2.8 3.1 min to rise from a baseline pressure of 4 cm H2O to a near-optimum pressure of 11 1 cm H2O. Once normal flow was reached CPAP slowly decreased, responding with great sensitivity to the slightest abnormality, especially snoring, but not changing in response to certain types of flow limitation. The pressure read visually on the AT was similar to the one recommended by PSG in most of the 39 patients (71%). The PSG performed after one month of using AT-recommended CPAP titration confirmed that the number of apneas, hypopneas (apnea/hypopnea index 6(1) and arousals (8 2) was normal for these SAHS patients. The AT increases pressure rapidly in the presence of respiratory events and maintains a normal breathing pattern in most patients. Visual reading of the AT pressure allows correct identification of the optimal CPAP setting for SAHS treatment.