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Making sense of significantly different leak rates - Printable Version

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Making sense of significantly different leak rates - verysincere - 10-02-2021

In my personal experience with BIPAP, a night with a very low AHI and low pressures & flow limitations tends to correlate with a very low leak rate.

Yet, sometimes I see a glaring exception which I am trying to understand. Two recent nights provide an example of such a contrast. Both had wonderful (and atypical for me) AHIs below 1.0 and low average pressures (and 0.0 flow limitations) yet significantly different Median and 95% leak rates:

Sep.29:  PRESSURE=16.60  AHI=0.83  FLOW LIMITATIONS=0.0   MEDIAN LEAK RATE=0.0,     95%LEAK RATE=0.0
Oct.01:  PRESSURE=16.48  AHI=0.44  FLOW LIMITATIONS=0.0   MEDIAN LEAK RATE=9.6,     95% LEAK RATE=15.60

(Yes, I was using the same hose and nasal-pillows on both nights.)

I care about such different leak rates because of the impact on airway dryness.  NOTE: I am using an elaborate combination of tennis bands, chin-lift-strap, velcro straps, cervical collar, and Balaclava full face hood in order to prevent mouth leaks.  (See attached photo.  Despite the appearance, I am not an ISIS terrorist about to perform an execution.)

Can you help me understand scenarios which can explain such a big difference under similar therapeutic conditions?