Autotitrating CPAP: Interpreting Studies By Dave Henry RRT DeVilbiss Healthcare Inc. 1 1
Disclaimer Appendix 3 Declaration of Vested Interest Form Name of presenter: Dave Henry RRT Name of employer: DeVilbiss Healthcare Definition: A presenter may have an interest in or affiliation with an organization, which does not prevent him or her from making a presentation, however, the audience must be informed of this relationship before the presentation of the activity. For this purpose a real or apparent conflict of interest is defined as having a significant financial interest in a product to be discussed directly or indirectly during the presentation; being or having been an employee of a company with such financial interest and/or having had substantial research support by an industry to study the product to be discussed at the presentation. I recognize that I must follow all guidelines and criteria regarding vested interest. [ ] No, I have no real or perceived conflicts of interests that relate to this presentation. (If the response is no, stop here.) [ X ] Yes, I have the following real or perceived conflicts of interest that relate to this presentation: Describe real or perceived conflicts of interest that relate to this presentation I am an employee of DeVilbiss Healthcare and we manufacture respiratory home care equipment. My presentations are not product specific but relate to the principles involved in best utilizing certain technologies in the home environment. 2 2
Learning Objectives Autotitrating CPAP Interpreting Studies 1. Given autotitrating study, determine the importance of the parameters. 2. Given the autotitrating study, determine how the whole study can be used in managing the patient s OSA. 3 3
REVIEW AutoAdjust Responders Either used to INCREASE the pressure with their PRESENCE or to DECREASE the pressure with their ABSCENCE Snoring 70 Hz Frequency Obstructive Apneas 90% Reduction for 10 Seconds Hypopneas 50% Reduction in flow for 10 seconds 4 4
REVIEW AutoAdjust Non Responders PREVENT the pressure from INCREASING because increasing the pressure would cause more of a problem. Leaks (mouth breathing or mask leaks) Loss of Amplitude and Increase in Blower Speed (looks like hypopnea) Expiratory Puffing (In through nose, out through mouth) Central Apneas Loss of expiratory flow and tail 95% Reduction in Flow for 10 Seconds 5 5
Guidelines for Reading Autotitrating Studies What is driving the Responders What is holding the Non Responders What is the graph telling you? Details 6 6
What is driving the Flow limitation Snores Apneas Hypopneas Guidelines for Reading Autotitrating Studies 7 7
Guidelines for Reading Autotitrating Studies What is holding the Leaks Mouth breathing Mask leaks Expiratory puffing Central apneas Other 8 8
Guidelines for Reading Autotitrating Studies What is the graph telling you? Amount of pressure change Railing Adherence to therapy 9 9
Picking Fixed CPAP Pressure from AutoAdjust Information What does the Daily Summary show? Look at multiple days. What does the Pressure Trending show? Optimum Pressure Highest average pressure. Effective Pressure Mean pressure between Peak and Average What does the Cumulative Pressure show? Percentage is amount of time at or BELOW stated pressure. 10 10
Prescribing Auto PAP Parameters to Adjust Pressure limits Lower pressure limit Upper Pressure limit Event definitions Apnea % Apnea duration Hypopnea % Hypopnea duration 11 11
Prescribing Auto PAP Parameters to Adjust Pressure limits (Routine setting of autotitrators) Lower pressure limit Comfortable for patient Suckin air Eliminate low pressure events Upper Pressure limit Prevent barotrauma Underlying lung disease Prevent non-adherence Patient not tolerating pressure so minimize setting so patient can tolerate high pressure limit 12 12
Prescribing Auto PAP Parameters to Adjust Event definitions Apnea % and duration More sensitive (less reduction) and respond quicker. Less (more reduction) and respond slower. Hypopnea % and duration. More sensitive (less reduction) and respond quicker Less sensitive (more reduction) and respond slower Most common adjustment to event definitions 13 13
Prescribing Auto PAP Formulas for setting pressure limits Default settings Leave settings alone and see what happens (AutoAdjust default is 5 lower pressure limit and 15 upper pressure limit) Certain Autotitrators Plus or minus a reference pressure 14 14
Case Studies 15 15
Case Study 1 Day 1 1. What s Driving the 2. What s Holding the 3. What s the Graph telling you? 4. What s the Average and Peak pressure on this day? 16 16
Case Study 1 Day 2 1. What s Driving the 2. What s Holding the 3. What s the Graph telling you? 4. What s the Average and Peak pressure on this day? 17 17
Case Study 1 Trending Graph 1. What is the Upper and Lower pressure limit set at? 2. What is the Highest peak 3. What is the Average peak 4. Pick an Optimal CPAP pressure for this patient? 5. What is the Lowest Average 6. What is the Mean Average 7. Pick an Effective CPAP pressure for this patient? 8. Pick Upper and Lower pressure limits as an autotitrator. 18 18
Case Study 1 Cumulative Pressure 1. How do you read Cumulative Pressure at 95? 2. What is the Cumulative Pressure at 95 3. What is the Cumulative Pressure at 90? 4. What is the Cumulative Pressure at 85? 5. How can this help in picking a Fixed CPAP 19 19
Case Study 1 Daily Usage 1. What does the Annual Usage Index tell us and how does it look? 2. What does Daily Usage tell us and how does it look? 3. What does the Standard Deviation tell us and how does it look? 20 20
Case Study 2 Day 1 1. What s Driving the 2. What s Holding the 3. What s the Graph telling you? 4. What s the Average and Peak pressure on this day? 21 21
Case Study 2 Day 2 1. What Driving the 2. What s Holding the 3. What s the Graph telling you? 4. What s the Average and Peak pressure on this day? 22 22
Case Study 2 Trending Graph 1. What is the Upper and Lower pressure limit set at? 2. What is the Highest Peak 3. What is the Average Peak 4. Pick an Optimal CPAP pressure for this patient? 5. What is the Lowest Average 6. What is the Mean Average 7. Pick an Effective CPAP pressure for this patient? 8. Pick Upper and Lower pressure limits as an autotitrator. 23 23
Case Study 2 Cumulative Pressure 1. How do you read Cumulative Pressure at 95? 2. What is the Cumulative Pressure at 95 3. What is the Cumulative Pressure at 90? 4. What is the Cumulative Pressure at 85? 5. How can this help in picking a Fixed CPAP 24 24
Case Study 2 Daily Usage 1. What does the Annual Usage Index tell us and how does it look? 2. What does Daily Usage tell us and how does it look? 3. What does the Standard Deviation tell us and how does it look? 25 25
Case Study 3 Day 1 1. What s Driving the 2. What s Holding the 3. What s the Graph telling you? 4. What s the Average and Peak pressure on this day? 26 26
Case Study 3 Day 2 1. What s Driving the 2. What s Holding the 3. What s the Graph telling you? 4. What s the Average and Peak pressure on this day? 27 27
Case Study 3 Trending Graph 1. What is the Upper and Lower pressure limit set at? 2. What is the Highest Peak 3. What is the Average Peak 4. Pick an Optimal CPAP pressure for this patient? 5. What is the Lowest Average 6. What is the Mean Average 7. Pick an Effective CPAP pressure for this patient? 8. Pick Upper and Lower pressure limits as an autotitrator. 28 28
Case Study 3 Cumulative Pressure 1. How do you read Cumulative Pressure at 95? 2. What is the Cumulative Pressure at 95 3. What is the Cumulative Pressure at 90? 4. What is the Cumulative Pressure at 85? 5. How can this help in picking a Fixed CPAP 29 29
Case Study 3 Daily Usage 1. What does the Annual Usage Index tell us and how does it look? 2. What does Daily Usage tell us and how does it look? 3. What does the Standard Deviation tell us and how does it look? 30 30
Case Study 4 Day 1 1. What s Driving the 2. What s Holding the 3. What s the Graph telling you? 4. What s the Average and Peak pressure on this day? 31 31
Case Study 4 Day 2 1. What s Driving the 2. What s Holding the 3. What s the Graph telling you? 4. What s the Average and Peak pressure on this day? 32 32
Case Study 4 Trending Graph 1. What is the Upper and Lower pressure limit set at? 2. What is the Highest Peak 3. What is the Average Peak 4. Pick an Optimal CPAP pressure for this patient? 5. What is the Lowest Average 6. What is the Mean Average 7. Pick an Effective CPAP pressure for this patient? 8. Pick Upper and Lower pressure limits as an autotitrator. 33 33
Case Study 4 Cumulative Pressure 1. How do you read Cumulative Pressure at 95? 2. What is the Cumulative Pressure at 95 3. What is the Cumulative Pressure at 90? 4. What is the Cumulative Pressure at 85? 5. How can this help in picking a Fixed CPAP 34 34
Case Study 4 Daily Usage 1. What does the Annual Usage Index tell us and how does it look? 2. What does Daily Usage tell us and how does it look? 3. What does the Standard Deviation tell us and how does it look? 35 35
Case Study 5 Day 1 1. What s Driving the 2. What s Holding the 3. What s the Graph telling you? 4. What s the Average and Peak pressure on this day? 36 36
Case Study 5 Day 2 1. What s Driving the 2. What s Holding the 3. What s the Graph telling you? 4. What s the Average and Peak pressure on this day? 37 37
Case Study 5 Trending Graph 1. What is the Upper and Lower pressure limit set at? 2. What is the Highest Peak 3. What is the Average Peak 4. Pick an Optimal CPAP pressure for this patient? 5. What is the Lowest Average 6. What is the Mean Average 7. Pick an Effective CPAP pressure for this patient? 8. Pick Upper and Lower pressure limits as an autotitrator. 38 38
Case Study 5 Cumulative Pressure 1. How do you read Cumulative Pressure at 95? 2. What is the Cumulative Pressure at 95 3. What is the Cumulative Pressure at 90? 4. What is the Cumulative Pressure at 85? 5. How can this help in picking a Fixed CPAP 39 39
Case Study 5 Daily Usage 1. What does the Annual Usage Index tell us and how does it look? 2. What does Daily Usage tell us and how does it look? 3. What does the Standard Deviation tell us and how does it look? 40 40
Prescribing Auto PAP Take Home Message! 1. Know Thy Device Understand Advantages AND Limitations 2. Customize to Your Patient Adjust settings to best TREAT your patient 3. Know How to READ Studies 41 41
And My Thanks to YOU! You will receive an Evaluation Form Complete and email back to address listed. We will send your CEU certificate via email. Thanks for attending! DAVE For more information concerning products mentioned in this presentation, go to www.devilbisshealthcare.com 42 42
For On Demand Programs Take the Quiz Complete the Quiz. If you have a passing score, it will prompt you to automatically print off your CEU certificate. If you have problems, follow prompts in www.devilbissclinicaleducation.com for assistance. Thanks for Attending! DAVE 43 43