Feasibility of type 3 polygraphy for evaluating leak determinants in CPAP-treated OSA patients: a step towards personalized leak management.

Abstract Background Unintentional leaks (ULs) are frequent adverse effects in CPAP-treated patients. We previously published a novel methodology for analyzing the determinants of UL using polysomnography. We now propose a simplified recording system using a type-3 polygraphic device (Somnolter®). Objectives 1) To describe individual UL determinants provided by the Somnolter® software in automatic-CPAP-treated OSA patients; 2) To subsequently describe the clinical consensus of 4 physicians on how to manage each individual UL situation. Methods Somnoler® recordings performed under nasal automatic-CPAP were automatically analyzed with APIOS software. For each polygraphic recording, APIOS provided the odds ratio and the confidence intervals for potential determinants of UL: mouth opening, CPAP pressure, body position and mandibular oscillation. Based on these results, each of four physicians was asked to choose one of four strategies: (i) increase/decrease therapeutic pressure; (ii) change nasal mask for oro-nasal mask/chinstrap; (iii) favor a non-supine/supine position; (iv) no action for individual leak management. Subsequently, a meeting was held to determine a consensus choice for each individual case. Results 78 consecutive patients underwent home-polygraphy with Somnolter®. Fifty recordings were analyzed (16 females; 65[57; 75]years; BMI=31.1[27.4; 35.3]kg/m2). Individual diagnosis of UL was routinely feasible. The determinants of UL were heterogeneous in the population and diagnosis of UL was not feasible in 10 patients. Based on the results from this analysis, we established consensus leak management strategies at the individual level. The average Cohen κ coefficient for the 4 raters was 0.58. Pressure modification was proposed in 36% of patients, no action in 24%, installation of a facial mask/chinstrap in 22% and positional treatment in 18%. Interpretation the use of type-3 polygraphy for characterizing leak determinants in patients treated with nasal automatic-CPAP is feasible in routine practice. Leak determinants are patient-specific. Inter-rater concordance for determining individual leak management strategies demonstrated a "fair" level of agreement.