01-28-2024, 02:14 AM
BiPAP Replacement Recommendation
I am looking for advice on a replacement machine for my ResMed S9 VPAP ST. The machine has recently been getting noisy and displaying messages about motor life exceeded. The humidifier also seems to be intermittent as it uses all the water one night and nearly none the next with similar sleep time and controlled humidity / temp in the house. The machine is over 10 years old so it is time to seek a replacement model.
My last sleep study summary is below. I am considering the AirCurve 10 ASV as a potential replacement.
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Sleep Study - Split Night PSG conducted in a sleep center
Impression: Complex Sleep Apnea, CPAP was attempted and failed to control central apneas, but the patient had an excellent response to BiPAP-ST with prolonged REM and N3 recorded.
Recommendation: Begin BIPAP ST Therapy at 14/10 RR 10cmH20.
Prescription: Complex Sleep Apnea Syndrome. Bi-Level pressure setting IPAP/EPAP 14/10, Mode ST, Backup Rate 10.
Diagnostic Sleep Study Summary: Latency to sleep onset of 16.5 minutes, 90% with a total sleep time of 167.0 minutes. 146 Respiratory events were observed which included 0 central apneas, 0 mixed apneas, 10 obstructive apneas, and 131 hypopneas. The apnea-hypopnea index was 50.7 which is severely elevated. A non-REM RDI of 52.0 and a REM RDI of 56.5. The longest respiratory event duration was 59.0 sec. Minimum NREM oxygen saturation was 80%, minimum REM oxygen saturation was 74%. Time spent below SaO2 of 90% was 49.4 minutes. Snoring was noted to be loud. 147 arousals were observed, with a total index of 52.8. There were 30 spontaneous arousals, 83 respiratory arousals (respiratory arousal index of 26.8) and 0 limb movement arousals. The mean heart rate was 63 bpm.
Titration Sleep Study Summary: Latency to sleep onset of 14.0 minutes, with reduced sleep efficiency of 83% and total sleep time of 240.0 minutes. Nasal CPAP was introduced and titrated from 4cm to 10cm and BIPAP ST 13/9 RR 10 - 14/10 RR 10. Snoring was eliminated at 10cm of pressure. Optimal pressure seems to be BIPAP ST 14/10 RR 10cm in terms of improving patients quality of sleep, snoring and apnea. 69 respiratory events were observed which included 29 central apneas, 1 mixed apnea, 15 obstructive apneas, and 24 hypopneas. The apnea-hypopnea index was 17.3 with a Non-REM RDI of 21.2 and a REM RDI of 0.0. The longest respiratory event duration was 34.5 seconds. Minimum NREM oxygen saturation was 88%, minimum REM oxygen saturation was 93%. Time spent below SaO2 of 90% was 2.1 minutes. 94 Arousals were observed, with a total index of 23.5. There were 16 spontaneous arousals, 31 respiratory arousals (respiratory arousal index of 20.8), and nine limb movement arousals. The mean heart rate was 59 bpm.
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My last sleep study summary is below. I am considering the AirCurve 10 ASV as a potential replacement.
--------------------------------------------------------------
Sleep Study - Split Night PSG conducted in a sleep center
Impression: Complex Sleep Apnea, CPAP was attempted and failed to control central apneas, but the patient had an excellent response to BiPAP-ST with prolonged REM and N3 recorded.
Recommendation: Begin BIPAP ST Therapy at 14/10 RR 10cmH20.
Prescription: Complex Sleep Apnea Syndrome. Bi-Level pressure setting IPAP/EPAP 14/10, Mode ST, Backup Rate 10.
Diagnostic Sleep Study Summary: Latency to sleep onset of 16.5 minutes, 90% with a total sleep time of 167.0 minutes. 146 Respiratory events were observed which included 0 central apneas, 0 mixed apneas, 10 obstructive apneas, and 131 hypopneas. The apnea-hypopnea index was 50.7 which is severely elevated. A non-REM RDI of 52.0 and a REM RDI of 56.5. The longest respiratory event duration was 59.0 sec. Minimum NREM oxygen saturation was 80%, minimum REM oxygen saturation was 74%. Time spent below SaO2 of 90% was 49.4 minutes. Snoring was noted to be loud. 147 arousals were observed, with a total index of 52.8. There were 30 spontaneous arousals, 83 respiratory arousals (respiratory arousal index of 26.8) and 0 limb movement arousals. The mean heart rate was 63 bpm.
Titration Sleep Study Summary: Latency to sleep onset of 14.0 minutes, with reduced sleep efficiency of 83% and total sleep time of 240.0 minutes. Nasal CPAP was introduced and titrated from 4cm to 10cm and BIPAP ST 13/9 RR 10 - 14/10 RR 10. Snoring was eliminated at 10cm of pressure. Optimal pressure seems to be BIPAP ST 14/10 RR 10cm in terms of improving patients quality of sleep, snoring and apnea. 69 respiratory events were observed which included 29 central apneas, 1 mixed apnea, 15 obstructive apneas, and 24 hypopneas. The apnea-hypopnea index was 17.3 with a Non-REM RDI of 21.2 and a REM RDI of 0.0. The longest respiratory event duration was 34.5 seconds. Minimum NREM oxygen saturation was 88%, minimum REM oxygen saturation was 93%. Time spent below SaO2 of 90% was 2.1 minutes. 94 Arousals were observed, with a total index of 23.5. There were 16 spontaneous arousals, 31 respiratory arousals (respiratory arousal index of 20.8), and nine limb movement arousals. The mean heart rate was 59 bpm.
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