SESSION TITLE: Sleep Posters
SESSION TYPE: Original Investigation Poster
PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM
PURPOSE: The flexible feature in positive pressure therapy devices can affect the response to Continuous Positive Airway Pressure (CPAP) therapy. Our patient was titrated in the lab with complete resolution of her apnea. However when she was sent home with the same settings she had worse control of her obstructive sleep apnea (OSA). That lack of home response to therapy was related to high expiratory pressure relief (EPR).
METHODS: A 51 year old female with history of hypertension who was referred to the sleep lab because of snoring, witnessed apnea and daytime hypersomnolence. No history of CHF or narcotic use.
RESULTS: Diagnostic polysomnogram revealed OSA with apnea - hypopnea index (AHI) 58 events per hour (100% obstructive events). Successful CPAP titration was performed by polysomnogram with AHI 4.8 (no central events) at final pressure of 8cm H2O. Patient was started at home on S8 Elite fixed CPAP 8 cm H2O with EPR 3 full time. In follow up, her AHI was 11.6 with appropriate levels of leak. Cardiopulmonary sleep study on her home CPAP settings indicated that the residual respiratory events were obstructive. CPAP was changed to S9 CPAP fixed 8 cm H2O with the EPR-3 for the ramping time and EPR-0 for the rest of the night. The AHI (recorded in 5 days) on this device was 0.9 and the level of leak decreased significantly.
CONCLUSIONS: This is a patient who had good response to fixed CPAP therapy in the sleep lab, but who developed residual obstructive respiratory events on home therapy. When the EPR features were removed from the device there was a total resolution of the residual events.
CLINICAL IMPLICATIONS: To troubleshoot high AHI on therapy we have to evaluate for type of respiratory events (central or obstructive) and assess for degree of mask leak. This case highlights the importance of considering the EPR feature as a reason for CPAP failure.
DISCLOSURE: The following authors have nothing to disclose: Sivaraman Sivaswami, Jody Tate, Askin Uysal, Cesar Liendo
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