RESUMEN
Most of the continuous positive airway pressure (CPAP) devices currently in use allow telemonitoring of observance, leaks and the apnoea-hypopnoea index (AHI). La Société française de recherche et de médecine du sommeil (SFRMS) and La Société de pneumologie de langue française (SPLF) workgroup offer to CPAP prescribers and to home care providers a scientific document which has the following purposes: to underline the relevance of the telemonitoring of leaks and the AHI, to define alert thresholds, to describe the principal mechanisms generating excessive leaks and high AHI, and to propose a diagnostic algorithm.
Asunto(s)
Algoritmos , Presión de las Vías Aéreas Positiva Contínua , Monitoreo Fisiológico , Neumología/normas , Apnea Obstructiva del Sueño/terapia , Telemedicina/normas , Presión de las Vías Aéreas Positiva Contínua/instrumentación , Presión de las Vías Aéreas Positiva Contínua/métodos , Presión de las Vías Aéreas Positiva Contínua/normas , Francia , Servicios de Atención de Salud a Domicilio/organización & administración , Humanos , Sistemas de Entrada de Órdenes Médicas/organización & administración , Sistemas de Entrada de Órdenes Médicas/normas , Monitoreo Fisiológico/métodos , Monitoreo Fisiológico/normas , Cooperación del Paciente , Pronóstico , Neumología/métodos , Neumología/organización & administración , Valores de Referencia , Apnea Obstructiva del Sueño/diagnóstico , Apnea Obstructiva del Sueño/epidemiología , Sociedades Médicas/organización & administración , Sociedades Médicas/normas , Telemedicina/métodosRESUMEN
This study aimed to assess the ability of an auto-nasal continuous positive airway pressure (nCPAP) device (REM + auto; NPBFD, Nancy, France) to predict the optimal constant nCPAP level. The apnoea/hypopnoea detection facility of the auto-nCPAP device was deliberately disabled and nasal mask pressure vibration detection was the only mode of pressure setting. The auto-nCPAP device was tested on 10 previously untreated patients with obstructive sleep apnoea during a single night, with ambulatory polysomnography performed in a conventional hospital room; the efficacy of the fixed pressure determined by the auto-nCPAP device was assessed by an ambulatory full polysomnography 2 weeks after the initiation of treatment at home. The fixed nCPAP pressure was effective (apnoea/hypopnoea and arousal indices <10 events x h(-1)) in all but two of the 10 patients studied. When the fixed nCPAP pressure was increased by 2 cmH2O in these two patients, sleep and respiration were normalized. Since only 12 ambulatory polysomnographic recordings were used to determine the effective nasal continuous positive airway pressure level, and as the device restored normal breathing and sleep in all 10 patients, it was concluded that this method of nasal continuous positive airway pressure titration may improve cost-effectiveness and reduce waiting lists in sleep laboratories.