• Marius Lebret, Dany Jaffuel, Carey M Suehs, Jean-Pierre Mallet, Loïc Lambert, Marie-Caroline Rotty, Jean-Louis Pépin, Eric Matzner-Lober, Nicolas Molinari, and Jean-Christian Borel.
• University of Grenoble Alpes, Grenoble, France; AGIR à dom. Association, Meylan, France. Electronic address: mariuslebret@gmail.com.
• Chest. 2020 Nov 1; 158 (5): 2165-2171.

BackgroundUnintentional 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; Nomics S.A.).Research Question(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 four physicians on how to manage each individual UL situation.Study Design And MethodsSomnoler recordings performed under nasal automatic-CPAP were automatically analyzed with APIOS software. For each polygraphic recording, APIOS provided the OR and the CIs 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: (1) increase or decrease therapeutic pressure; (2) change nasal mask for oro-nasal mask/chinstrap; (3) favor a nonsupine or supine position; (4) no action for individual leak management. Subsequently, a meeting was held to determine a consensus choice for each individual case.ResultsSeventy-eight consecutive patients underwent home-polygraphy with Somnolter. Fifty recordings were analyzed (16 females; 65 [57-75] years of age; BMI = 31.1 [27.4-35.3]). 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 four 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%.InterpretationThe 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. Interrater concordance for determining individual leak management strategies demonstrated a "fair" level of agreement.Trial RegistryClinicalTrials.gov; No.: NCT03381508; URL: www.clinicaltrials.gov).Copyright © 2020 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

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