title: Novel Approach to Simulate Sleep Apnea Patients for Evaluating Positive Pressure Therapy Devices.
abstract: Bench testing is a useful method to characterize the response of different automatic positive airway pressure (APAP) devices under well-controlled conditions. However, previous models did not consider the diversity of obstructive sleep apnea (OSA) patients' characteristics and phenotypes. The objective of this proof-of-concept study was to design a new bench test for realistically simulating an OSA patient's night, and to implement a one-night example of a typical female phenotype for comparing responses to several currently-available APAP devices. We developed a novel approach aimed at replicating a typical night of sleep which includes different disturbed breathing events, disease severities, sleep/wake phases, body postures and respiratory artefacts. The simulated female OSA patient example that we implemented included periods of wake, light sleep and deep sleep with positional changes and was connected to ten different APAP devices. Flow and pressure readings were recorded; each device was tested twice. The new approach for simulating female OSA patients effectively combined a wide variety of disturbed breathing patterns to mimic the response of a predefined patient type. There were marked differences in response between devices; only three were able to overcome flow limitation to normalize breathing, and only five devices were associated with a residual apnea-hypopnea index of <5/h. In conclusion, bench tests can be designed to simulate specific patient characteristics, and typical stages of sleep, body position, and wake. Each APAP device behaved differently when exposed to this controlled model of a female OSA patient, and should lead to further understanding of OSA treatment.
authors.affiliation: Unitat de Biofísica i Bioenginyeria, Facultat de Medicina, Universitat de Barcelona, Barcelona, Spain.|CIBERES, Madrid, Spain.
authors.forename: Valentina
authors.initials: V
authors.lastname: Isetta
authors.affiliation: CIBERES, Madrid, Spain.|Sleep Laboratory, Pneumology Department, Hospital Clinic, Barcelona, Spain.|Institut d'Investigacions Biomèdiques August Pi i Sunyer, IDIBAPS, Barcelona, Spain.
authors.forename: Josep M
authors.initials: JM
authors.lastname: Montserrat
authors.affiliation: Unitat de Biofísica i Bioenginyeria, Facultat de Medicina, Universitat de Barcelona, Barcelona, Spain.
authors.forename: Raquel
authors.initials: R
authors.lastname: Santano
authors.affiliation: ResMed Science Centre, Munich, Germany.
authors.forename: Alison J
authors.initials: AJ
authors.lastname: Wimms
authors.affiliation: ResMed Science Centre, Munich, Germany.
authors.forename: Dinesh
authors.initials: D
authors.lastname: Ramanan
authors.affiliation: ResMed Science Centre, Munich, Germany.
authors.forename: Holger
authors.initials: H
authors.lastname: Woehrle
authors.affiliation: Unitat de Biofísica i Bioenginyeria, Facultat de Medicina, Universitat de Barcelona, Barcelona, Spain.|CIBERES, Madrid, Spain.|Institute for Bioengineering of Catalonia, IBEC, Barcelona, Spain.
authors.forename: Daniel
authors.initials: D
authors.lastname: Navajas
authors.affiliation: Unitat de Biofísica i Bioenginyeria, Facultat de Medicina, Universitat de Barcelona, Barcelona, Spain.|CIBERES, Madrid, Spain.|Institut d'Investigacions Biomèdiques August Pi i Sunyer, IDIBAPS, Barcelona, Spain.
authors.forename: Ramon
authors.initials: R
authors.lastname: Farré
mesh_terms: D003198:Computer Simulation; D004867:Equipment Design; D005260:Female; D006801:Humans; D008953:Models, Anatomic; D010641:Phenotype; D017286:Polysomnography; D011175:Positive-Pressure Respiration / Q000295:instrumentation*; D011187:Posture; D011312:Pressure; D012119:Respiration; D012212:Rheology; D012891:Sleep Apnea Syndromes / Q000503:physiopathology* / Q000628:therapy; D012892:Sleep Deprivation / Q000503:physiopathology; D012894:Sleep Stages / Q000502:physiology; D012913:Snoring; D014851:Wakefulness