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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_4696_Библиотеки_им_академика_М_И_Перельмана
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151
veried. The pressure strategy adopted followed the recommendations of the
American Thoracic Society (ATS), where studies have observed that ambulatory
stable patients with obesity hypoventilation and high apnea-hypopnea index may be
adequately responsive to CPAP (Fig.10.1) [3, 4].
After the CPAP test, a test was also performed using the pressure device in
bilevel therapeutic mode (IPAP 15.0 cmH
2
O and EPAP 8.0 cmH
2
O); however, the
patient reported discomfort and was very resistant to proceed with the tests in that
pressure mode, with a clear preference for using the CPAP device.
It was interesting to observe that at a CPAP of 14 cmH
2
O, even with a respiratory
disturbance, oxygen desaturation does not occur, according to the reading of the
oximetry module attached to the device (Fig.10.2). This nding is in line with the
ATS guideline, which favors the use of CPAP over NIV for approximately two-
thirds of patients with severe OSA concomitant with hypoventilation due to obesity.
According to that guideline, although noninvasive ventilation monitoring (i.e.,
transcutaneous CO
2
) theoretically should be added to SaO
2
monitoring for PAP
titration or adjustment, no comparative studies were found using SaO
2
monitoring
with or without non-invasive CO
2
monitoring. This domain needs further investiga-
tion. And often healthcare professionals need to consider options based on resource
availability [3].
Fig. 10.1 Provides a ow diagram for suggested indications for outpatient NIV support for awake
or sleep hypoventilation. (Source: Mokhlesi B etal., 2021 (with permission) [4])
10.2 Therapeutic Intervention
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152
Navigation panel (8 hours window)
Detailed panel (1 minute window)
Obstructive apnea
Leak
(1/min)
Respirator
y flow
(1/min)
Respirato
ry flow
(1/min)
Respiratory
events
Respiratory
events
SaO2
SaO2
Fig. 10.2 In this gure, we can see that, at a CPAP of 14 cmH
2
O, even with a respiratory distur-
bance, oxygen desaturation does not occur, according to the reading of the oximetry module
attached to the device. Saturation remains higher than 90% after obstructive apnea (dotted line).
(Source: author’s collection)
At follow-up, the patient continued with excellent CPAP compliance, reporting
signicant improvement in mood and daytime sleepiness with the use of positive
airway therapy.
Take Away Message
1. Evidence-based practice is critical for effective clinical management.
2. Currently, positive pressure devices provide technologies that enable remote
monitoring and treatment adaptations quickly and accurately.
3. The oximetry module associated with positive pressure device is an essential
resource for the proper monitoring of patients in the sleep eld. The statistical
report indicating the resolution of respiratory events throughout the night does
not indicate improvement in ventilatory disorders, and health professionals
should be aware of this.
4. The evaluation of the ow curve throughout the night, associated with the oxim-
etry signal, is a powerful tool that allows assessing whether any desaturations are
occurring due to sleep apneas or not.
References
1. Schutte-Rodin S. Telehealth, telemedicine, and obstructive sleep apnea. Sleep Med Clin.
2020;15(3):359–75. https://doi.org/10.1016/j.jsmc.2020.05.003.
10 Case Report: Obstructive Sleep Apnea andObesity Hypoventilation Syndrome
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153
2. Weaver TE.Novel aspects of CPAP treatment and interventions to improve CPAP adherence. J
Clin Med. 2019;8(12):2220. https://doi.org/10.3390/jcm8122220.
3. Mokhlesi B, Masa JF, Brozek JL, Gurubhagavatula I, Murphy PB, Piper AJ, etal. Evaluation
and management of obesity hypoventilation syndrome. An ofcial American Thoracic Society
clinical practice guideline. Am J Respir Crit Care Med. 2019;200(3):e6–e24. https://doi.
org/10.1164/rccm.201905- 1071ST.
4. Mokhlesi B, Won CH, Make BJ, Selim BJ, Sunwoo BY, OTE P.Optimal noninvasive medi-
care access promotion: patients with hypoventilation syndromes a technical expert panel report
from the American College of Chest Physicians, the American Association for Respiratory
Care, the American Academy of sleep medicine, and the American Thoracic Society. Chest.
2021;160:e377. https://doi.org/10.1016/j.chest.2021.06.083.
References
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A
Airow curves, 30
Airow limitation, 63
Ambulatory Blood Pressure Monitoring
(ABPM), 130
American Academy of Sleep Medicine
(AASM), 62, 63
Apnea-hypopnea index (AHI), 13, 16, 18, 58,
75, 121, 143
Automatic CPAP (APAP), 16
B
Blood pressure (BP), 134
Breath detection, 27
C
Central sleep apnea (CSA), 15
CSR, 86, 87
non-Cheyne-Stokes periodic pattern, 87, 88
overview, 85
TECSA, 90
Cheyne-Stokes respiration (CSR), 69,
73, 86, 87
Continuous positive airway pressure (CPAP),
14–16, 71, 90, 131, 134
COVID-19 vaccine, 127
Cyclical neuroanatomic interaction, 5
D
Drug induced sleep endoscopy (DISE), 102
E
Epiglottic collapse, 102, 103
F
Flow curve analysis software, 30–36
H
Heart failure, 86, 87
Hypopnea index (HI), 58
I
Isometric airway ow curve, 112–113
L
Loop gain (LG), 6, 8, 97–99
M
Mandibular advancement device (MAD),
143, 144
Microarousal
patient history, 127–129
therapeutic intervention
ABPM, 130
CPAP, 131, 134
respiratory ow curve, 130–133
Mixed apneas, 59–62, 88–89, 129,
144
Myofunctional therapy, 146
Index
© The Editor(s) (if applicable) and The Author(s), under exclusive license to
Springer Nature Switzerland AG 2023
V. S. Piccin, Monitoring Positive Pressure Therapy in Sleep-Related Breathing
Disorders, https://doi.org/10.1007/978-3-031-50292-7
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N
Non-Cheyne-Stokes, 87–88
Non-rapid eye movement (NREM) sleep, 3–5,
9, 96, 97, 108, 109, 144, 145
O
Obesity hypoventilation syndrome (OHS), 10
patient history, 149, 150
therapeutic intervention, 150–152
Obstructive sleep apnea (OSA), 13, 57, 59, 84
patient history, 149, 150
stroke
patient history, 119–121
therapeutic intervention, 122–125
therapeutic intervention, 150–152
unintentional leakage
patient history, 143–145
therapeutic intervention, 146, 147
Oronasal mask, 17, 19, 99, 105, 146
P
Palatal prolapse, 101, 102
Paradoxical sleep, 4
Periodic breath algorithm detection, 69–73
Polysomnography (PSG)
breathing events, 78
mixed apnea, 60–62
obstructive/central apnea, 58–61
obstructive/central hypopnea
AASM, 62, 63
exhalation ow curve, 65, 67
inspiratory ow curve, 63–66
ResMed algorithm, 63
oximeter adapter, 79
oxygen desaturation, 79
wireless high-resolution
oximeter, 79, 80
periodic breathing, 69, 72–74
pressure graph, 77, 78
RERA, 65, 68–72
snore index, 74–76
unintentional leak, 77
Positional sleep apnea
patient history, 137–139
therapeutic intervention, 139–141
Positive airway pressure (PAP)
adherence, 16, 17
ethical concerns, 21
patient monitoring, 17–19
telemonitoring, 19, 20
treatment, 13–16
R
Rapid eye movement (REM), 3–5, 10, 96, 106,
143, 144, 149
Respiratory effort-related arousals (RERA),
65, 68–72, 92–94
Respiratory ow curve
assessment, 25–27
breath detection, 27
breathing pattern, 96, 97
catathrenia, 108–110
central hypopnea, 91, 92
central sleep apnea
CSR, 86, 87
non-Cheyne-Stokes periodic
pattern, 87, 88
overview, 85
TECSA, 90
epiglottic collapse, 102, 103
equipment, 103, 104
health care professionals
data receiving, 44
data sending, 44–47
patient instruction, 45–50
isometric airway ow curve trace, 112, 113
linearization of signals, 28, 29
loop gain, 97–99
mixed apneas, 88, 89
obstructive hypopnea, 91, 92
obstructive sleep apnea, 84
oximetry module, 110–112
palatal prolapse, 101, 102
pressure variations, 28
procedure, 50–54
quality of, 28, 29
RERAs, 92
respiratory parameters, 27
ResScan
TM
program
air ow data, 30
assessment date, 37–43
data transfer, 31, 33–35
high-resolution data, 31, 35, 36
patient data, 30, 31
program access, 30, 32
sampling rate, 29
sighs, 106, 107
snoring index, 94, 95
unintentional leakage, 99–101, 105, 106
ResScanTM program
AirFit F20 oronasal mask, 17
AirFit N20 nasal mask, 17
AirFit P10 pillow mask, 17
air ow data, 30
assessment date, 37–43
Index
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data transfer, 31, 33–35
high-resolution data, 31, 35, 36
patient data, 30, 31
program access, 30, 32
S
Sleep stages
characteristics, 3–5
respiratory control system
carbon dioxide changes, 5, 7
Control Gain, 6, 7
elements, 5, 6
loop gain, 6, 8
Plain Gain, 6, 7
respiratory sleep disorders, 8–10
Stroke
patient history, 119–121
therapeutic intervention, 122–125
Support pressure, 15
T
Time of inspiratory (TI) stretching, 65
Total sleep time (TTS), 144
Treatment-emergent central sleep apnea
(TECSA), 73, 90
U
Unintentional leakage, 77, 99–101
Upper airway (UA), 59
Upper airway resistance syndrome
(UARS), 10
V
Ventilatory delta, 15
W
Wireless high-resolution oximeter, 79–80
Index
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