The following is the summary of  “Impact of Unintentional Air Leaks on Automatic Positive Airway Pressure Device Performance in Simulated Sleep Apnea Events” published in the January 2023 issue of Respiratory Care by Fasquel, et al.

If you suffer from obstructive sleep apnea, you should know that positive airway pressure (PAP) is the gold standard treatment. More and more people have turned to  automatic PAP (APAP) adjustment modes in recent decades. When the pressure is set to automatically adjust, the patient is more at ease, and the physician receives significant assistance in providing the best possible care. In spite of this, device functionality can vary depending on the maker. It is crucial to examine the efficiency of the most popular devices since the amount of unintended air leaks has a significant impact on the outcome of the therapy. 

This research set out to examine the efficacy of 3 distinct APAP devices from 3 different popular manufacturers under varying settings (obstructive sleep apnea, central sleep apnea, and hypopnea) and with and without accidental air leak.  This was a bench study. A breathing simulator with a Starling resistor (representing the upper airways) and an adjustable inadvertent air leak valve was used to test the device’s performance. Different conditions were used to evaluate three APAP devices (AirSense 10, DreamStation, and Prisma 20A). The performance of the 3 systems was comparable to that described in the literature when there was no accidental air loss. However, in other cases, performance was affected by the presence of an inadvertent air leak. (Intraclass correlation coefficient (ICC) = 0.021, P=.61) for obstructive apnea; (ICC = 0.059, P=.26) for hypopnea; AirSense 10 failed to detect either. 

Prisma 20A performed worse in the obstructive apnea simulation (ICC 0.708, P<.001). The simulated hypopnea events were the worst for DreamStation (ICC 0.755, P<.001). The results show that the 3 APAP machines reacted differently to the extra air leak. Some devices’ altered performance may have an impact on the efficacy of treatment for patients with sleep apnea syndrome. Clinicians should reconsider the use of APAP devices in the home due to the performance variability of some models, which includes air leakage that isn’t intended.