Case study
Jerry’s history
Jerry is a 65-year-old banker who had visited the Sleep Management Institute several times. He had a history of heart failure with atrial fibrillation and severe sleep apnea. A sleep study from 2004 showed an AHI of 54.6 and sleep efficiency of 80.4 with oxygen saturation as low as 79%. Despite complaints of daytime sleepiness, Jerry was reluctant to try CPAP therapy.
One day as Jerry was pulling into a fast food drive-through, he fell asleep behind the wheel and ran into the side of a building. That was his sign that he needed to make a change.
Partial response to bilevel
Following his car accident, Jerry returned to the Sleep Management Institute for a CPAP titration sleep study. For the 2006 study, total respiratory disturbance index (RDI) was 94.5 during the pre-treatment portion of the study. Central apneas were prevalent during the treatment portion of the study with a central apnea index of 16.6.
During treatment with bilevel, Jerry reported toleration issues, therefore initial pressure was started at 4 cm H2O. Central apneas became more frequent as the pressure was increased. Bilevel pressure was applied up to 13/6 cm H2O, but the RDI remained high at 73.9.
Positive response to VPAP Adapt SV
Jerry was next titrated on VPAP Adapt SV. Central apneas were eliminated immediately. Some mild obstructive hypopneas continued initially and were reduced as the end expiratory pressure (EEP) was increased from 5 cm H2O to 9 cm/H2O. The obstructive hypopneas were controlled with the EEP at 9 cm H2O with an RDI of 3.8. Oxygen saturation remained above 90%. Jerry was sent home with a device to start VPAP Adapt SV therapy. When Jerry next spoke with Dr. Corser, he reported feeling awake and alert. He was no longer drowsy and his snoring had been virtually eliminated. Moreover, Jerry experienced the following health benefits:
- Ankle swelling reduced
- Dyspnea completely eradicated
- Reduced hypertension and nocturnal hypoxemia
- Nocturia 4-5 times per night eliminated
In addition to the benefits to his health, Jerry’s home life has also improved. His wife is happy because he’s no longer falling asleep right after work, and Jerry reports feeling more energetic and focused.
"We’ve had patients (like Jerry) continue to have high AHI with central events, despite our best efforts to titrate with CPAP and bilevel. With these complex patients, VPAP Adapt SV effectively normalizes breathing where the other therapies have failed. It makes our lives easier because our patients’ lives are improved. I’m very impressed with it."
Bruce Corser, MD
Sleep Management Institute