All APAPs Are Not Equivalent for the Treatment of Sleep Disordered Breathing: A Bench Evaluation of Eleven Commercially Available Devices

J Clin Sleep Med. 2015 Jul 15;11(7):725-34. doi: 10.5664/jcsm.4844.


Study objectives: This study challenged on a bench-test the efficacy of auto-titrating positive airway pressure (APAP) devices for obstructive sleep disordered breathing treatment and evaluated the accuracy of the device reports.

Methods: Our bench consisted of an active lung simulator and a Starling resistor. Eleven commercially available APAP devices were evaluated on their reactions to single-type SDB sequences (obstructive apnea and hypopnea, central apnea, and snoring), and to a long general breathing scenario (5.75 h) simulating various SDB during four sleep cycles and to a short scenario (95 min) simulating one sleep cycle.

Results: In the single-type sequence of 30-minute repetitive obstructive apneas, only 5 devices normalized the airflow (> 70% of baseline breathing amplitude). Similarly, normalized breathing was recorded with 8 devices only for a 20-min obstructive hypopnea sequence. Five devices increased the pressure in response to snoring. Only 4 devices maintained a constant minimum pressure when subjected to repeated central apneas with an open upper airway. In the long general breathing scenario, the pressure responses and the treatment efficacy differed among devices: only 5 devices obtained a residual obstructive AHI < 5/h. During the short general breathing scenario, only 2 devices reached the same treatment efficacy (p < 0.001), and 3 devices underestimated the AHI by > 10% (p < 0.001). The long scenario led to more consistent device reports.

Conclusion: Large differences between APAP devices in the treatment efficacy and the accuracy of report were evidenced in the current study.

Keywords: auto-titrating continuous positive airway pressure; bench test; central sleep apnea; device report; obstructive sleep apnea.

Publication types

  • Comparative Study
  • Evaluation Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Automation
  • Benchmarking / methods*
  • Equipment Design
  • Equipment Failure Analysis / methods*
  • Equipment Safety
  • Humans
  • Positive-Pressure Respiration / instrumentation*
  • Positive-Pressure Respiration / methods
  • Reproducibility of Results
  • Sleep Apnea Syndromes / diagnosis
  • Sleep Apnea Syndromes / therapy*
  • Sleep Apnea, Central / diagnosis
  • Sleep Apnea, Central / therapy
  • Sleep Apnea, Obstructive / diagnosis
  • Sleep Apnea, Obstructive / therapy