AVAPS Initial Pressure Settings

Initial AVAPS Settings

• The American Academy of Sleep Medicine recommends starting with EPAP at 4 cm H₂O, minimum IPAP at 8 cm H₂O, and maximum IPAP at 25-30 cm H₂O, with a target tidal volume of approximately 8 mL/kg ideal body weight 1
• For patients ≥12 years, the maximum IPAP should not exceed 30 cm H₂O, while for patients <12 years, it should not exceed 20 cm H₂O 2, 3, 4
• The target tidal volume should be 8 mL/kg ideal body weight, with an acceptable range of 6-8 mL/kg ideal body weight 1, 2, 3

Titration Strategy

• The American Academy of Sleep Medicine guidelines suggest adjusting EPAP first to eliminate obstructive apneas, hypopneas, RERAs, and snoring, and then adjusting IPAPmax as needed 1, 2, 3, 4
• If the device consistently reaches IPAPmax without achieving target tidal volume, IPAPmax should be increased in 2 cm H₂O increments, with a maximum incremental change of 2 cm H₂O to avoid over-titration 2, 3, 4

Mode Selection

• The American Academy of Sleep Medicine recommends using ST mode with AVAPS for patients with central hypoventilation, central apneas, muscle weakness, or inadequate ventilation 7
• The backup rate should be set equal to or slightly less than the spontaneous sleeping respiratory rate, with a minimum of 10 bpm 7

Clinical Evidence Supporting AVAPS

• AVAPS has been shown to achieve lower nocturnal PtcCO₂ compared to standard BPAP-ST, with a mean difference of 6.9 mm Hg 5, 6
• The American Academy of Sleep Medicine recommends using AVAPS for patients who require guaranteed minute ventilation while adapting to changing patient needs 1

Monitoring Parameters

• The American Academy of Sleep Medicine recommends monitoring tidal volume, leak, and patient comfort during titration, with a target tidal volume of 6-8 mL/kg ideal body weight 2, 3
• The target goals for monitoring parameters include a pH improvement toward normal, a PCO₂ reduction to ≤10 mm Hg above awake baseline, and an SpO₂ maintenance of 88-94% 2, 7, 8