Industry experts discuss the latest trends and developments in CPAP masks and systems.

By Cassandra Perez

RT Magazine gathered several industry experts for a panel discussion on CPAP masks and interfaces. The participants discussed the latest and trends and developments in CPAP therapy equipment as well as the newest advancements. In addition, the panel experts reviewed the equipment features that can help improve patient compliance, the ways in which clinicians can strive to improve pediatric compliance, and what the future may hold for the CPAP devices market.

The participants in this panel discussion were:

  • Kent Anselmi, national sales manager, emergency and pre-hospital, Pulmodyne;
  • Mark D’Angelo, sleep business leader, Philips;
  • Angela Giudice, RPSGT, clinical education manager, 3B Medical Inc;
  • Susie Justus, clinical support specialist and licensed vocational nurse, ResMed; and
  • Kelly Rudolph, president, Hans Rudolph Inc.

RT: What are the latest trends and developments in CPAP systems and CPAP masks/interfaces?

Kent Anselmi (Pulmodyne): The acceptance of CPAP has grown at a rapid rate over the past several years in the pre-hospital arena with the latest trends being in, disposable for effective and rapid deployment to treat the patient’s respiratory emergency bedside. Masks need to be easy to apply, providing patient comfort while providing an excellent seal. The mask should also be pliable enough to seal around cannulas or ETCO2 devices.

Mark D’Angelo (Philips): Connected health technology including smart, connected CPAP systems, is becoming a reality across many areas of healthcare and is an answer to improving therapy for sleep-disordered breathing patients in the new world of outcomes-driven reimbursement. Backed by data-driven information that enables tailored patient care and greater therapy compliance, connected CPAP systems offer a range of new opportunities for providers to stay virtually connected to the patient and coach them more efficiently and effectively to success.

Angela Giudice (3B Medical): Most of the trends in CPAP systems center of software connectivity and integration of data systems. Most of the vendor advancements will likely revolve around variations of wireless connectivity (ie cellular data, WiFi, Bluetooth) and other free connectivity options. The trends in masks are primarily on reduction of costs through lighter weight interfaces with fewer parts.

Susie Justus (ResMed): Patient demand and an increasingly competitive business environment for home medical equipment providers (HMEs), has led to innovation in the design of today’s CPAP systems and masks. ResMed’s focus is on developing products that make treatment more comfortable and effective for patients, while making business easier for our HME partners. Our new masks are smaller, lighter, and allow for more comfortable treatment for patients and their bed partners.

Our latest CPAP devices include integrated humidification and new comfort features for patients, as well as integrated wireless connectivity so that healthcare providers and HMEs can automatically receive regular reports on patients’ progress and provide coaching in instances of compliance challenges. Advances in flow generators, masks, and reliable access to data, can work together to help patients continue on therapy and drive toward healthy outcomes.

Another change in the development of CPAP comes from the fact that more women are becoming aware of the impact sleep apnea can have on their health, and 40% of new patients receiving sleep studies are now women. This has led to new treatment options tailored to women’s specific symptoms, marking another shift in therapy development.

Kelly Rudolph (Hans Rudolph): Trends include a softer sealing flange, better sealing, lighter weight, lower price, more adaptable to various face geometries, ease of use, availability, and covering both nose and mouth. We the designers and manufacturers at Hans Rudolph have designed the last two series of full face masks to have all these features to meet the latest market demands worldwide. Our masks offer two of the lowest prices on the market and our latest, which we named the QUEST, is priced to win in the competitive bidding environment that the DMEs and RTs live in today.

RT: Describe some of the latest advancements in your company’s CPAP systems and/or masks/interfaces.

Anselmi: Pulmodyne has led the way for many years in disposable CPAP by using the high flow port like most ventilators to supply unrestricted flow. The first disposable was the O2-RESQ followed by the O2-MAX, both of which are still widely used throughout the world. Using a Venturi system, the flow to the patient is approximately 140 LPM with a fixed FiO2 of 30%. If higher oxygen concentrations are needed, the O2-MAX with the application of our TRIO attachment has an FiO2 that can be increased from 30% to 60-90% by just turning a dial. Both use our BiTrac ED mask, which is a hospital grade mask and can be used throughout the clinical setting. The latest advancement with Pulmodyne in CPAP is incorporating the closed nebulizer port into the CPAP circuit. This allows the healthcare professional to nebulize whenever necessary, while delivering CPAP therapy without the potential of desaturating the patient while placing a T-Tube in place. Also, with our 4 disposable Quik-Connects, oxygen connection is made extremely easy.

Giudice: A large portion of our research and development effort has been associated with improvements in our online patient management program, iCodeConnect, as well as integration with other data systems (ie payer systems, resupply systems, etc). 3B Medical recently announced a new product, 3B Patient TouchPoint, which acts as a patient coach, identifying at-risk patients, proactively notifying the clinical team of patients slipping in compliance. Our goal is to help DMEs work smarter and not harder, by allowing them to focus limited resources on the patients that need the help. These, and other advancements in our connectivity and wireless pathway are front and foremost in our technology push.

3B Medical has two new mask interfaces on the market, the recently released iO mini-nasal and the Elara full face. The iO is a small, streamlined, lightweight nasal mask with an easily  removable cushion and  updated comfort headgear. The 3B Elara fullface mask is a comfortable, soft silicone mask with no forehead piece, allowing patients to easily wear eyeglasses and have no vision obstruction. This mask is very comfortable and at just 2.5 oz for the smallest size it’s one of the lightest masks available.

D’Angelo: Amara View is the latest addition to Philips’ portfolio of masks that meets the unique needs of a diverse OSA patient population. Amara View covers less of a patient’s face than any of the leading full-face masks, minimizing the feelings of claustrophobia. Amara’s innovative design helps to minimize and prevent bothersome red marks and discomfort on the bridge of the nose. Additionally, patients can wear glasses, read or watch TV while wearing the Amara View. This makes Amara View an ideal choice for someone who doesn’t want to see their bedtime routine disrupted by their therapy.

As with each of our masks, our intent is to provide products that support patients’ long-term adherence to their therapy while providing value to the homecare provider serving the patient. Our design process focuses on insights from patients, clinicians, and physicians, and providing simple, effective and appealing solutions to their collective challenges. We plan to continue to enhance our mask offerings to provide patients and HMEs with the options they desire to make CPAP therapy feel like a natural part of a good night’s sleep.

Justus: We most recently debuted our AirCurve 10 series, intended to provide specialized support for challenging sleep apnea cases, including patients who need extra pressure support or have difficulty using a fixed pressure device. The AirCurve line encompasses three bilevel devices, as well as an adaptive servo-ventilation device for patients with central sleep apnea and Cheyne-Stokes respiration. AirCurve devices include adjustable pressure settings for specialized support as well as a built in humidifier with climate control capabilities. The new device line is part of our Air Solutions ecosystem of end-to-end solutions and integrates seamlessly with its connected-care platform, AirView, along with the U-Sleep patient management platform and myAir patient engagement tools. U-Sleep automatically identifies and sorts patients into actionable groups and helps HMEs to coach via phone, E-mail, or text, while myAir is a personalized coaching tool on patients’ devices and masks that includes how-to instructions, videos, and other support materials that help patients stay on track.

Rudolph: We make our Full Face CPAP Masks with a leading edge technique that eliminates all the complicated parts, does not have a hard frame (which avoid pressure sores), and gives the patients and their RTs a replaceable face piece that is made from only a single piece of soft material, eliminating costly replacements. The unique design allows the mask to fit into the patient’s face and not on top of their face, and therefore it seals great, and since it has a chin shelf (fits under the chin) it will not ride up their face and stays on all night allowing them to sleep well.

We just developed a new mask named the QUEST that is lighter weight and lower price than our very successful 7600 V2 Hans Mask that has been on the market. QUEST has all the exact design geometries and headgear but made in lighter weight materials and sold at half the price.

RT: In what ways are pediatric masks/interfaces changing? What are some ways RTs/clinicians can help maximize compliance when CPAP is prescribed for children?

 D’Angelo: Pediatric masks, much like those designed for adults, are becoming smaller and lighter. This design movement is enabling RTs to find masks that fit pediatric patients better and more comfortably, which helps to bolster compliance.

Justus: ResMed has a long history of pediatric mask development: our pediatric masks being the first to be cleared by the FDA for obstructive sleep apnea treatment in children. Our current offerings include the Pixi, designed for children between the ages of 2 to 7, and the Mirage Kidsta, designed for children ages 7 and older. Each was designed specifically for pediatric use and includes child-friendly features, such as comfortable cushions better-suited for softer faces. ResMed also provides educational tools and picture books about sleep apnea to help children better understand their therapy.

Rudolph: We make smaller, softer, pediatric-specific geometries to meet the needs of the smaller faces. Work with the pediatric patients when fitting and make sure they understand that the mask will not hurt them and only help them.

RT: What types of changes can patients and respiratory therapists expect to see in the future for the CPAP devices market?

D’Angelo: Connected health technology affords clinicians new ways to encourage patients to take a more active role in their care. Virtual coaches that are accessible via desktop and mobile devices can provide patients with basic information about their disorder, tips on mask fit and cleaning, and insight into their apnea hypopnea index (AHI). Clinicians will have more educational tools to offer patients, including guidance on how best to use therapy on a day-to-day basis.

Aided by risk-scoring algorithms, clinicians can identify at-risk patients for interventional management and then focus on the patients that need the most assistance while reducing high-touch follow up with those who have adjusted well to therapy.

Giudice: Software for CPAP and compliance reporting will continue to become more sophisticated, offering more connectivity options and easier report uploading with minimal effort for both patient and clinicians. Due to increasingly stringent insurance requirements, patients will need to become a more active part in their therapy, understanding why their compliance is needed and how to properly use the tools available to them. Mask interfaces will keep being designed for comfort and wearability, with more technical fabrics and materials, and streamlined, lightweight designs. Proper mask fit is key to patient compliance and an ever-broadening market and mask style choices will make individual preference and fit an attainable goal for each patient.

The CPAP therapy market today is a challenging and exciting environment that is forced to evolve to reflect reimbursement and more modern therapy educated patients. Patients themselves need to be the focus and future concern of our industry. CPAP needs to be a realistic, comfortable treatment option for sleep apnea patients.

Justus: Patient demand for improved masks and technologies has remained consistent. It’s likely that we’ll continue to see smaller, lighter, and more comfortable masks, while data connectivity options for bedside devices grow in their capabilities and scope. I also expect to see continued patient engagement efforts in the space: right now, there’s a core group of patients who are most interested in accessing and tracking their data, but as time goes on and engagement efforts increase, that cadre will grow. I’m optimistic that patients will eventually be as concerned about their sleep quality and quantity as others are about calories, step counters, and minutes of activity in a day, if not more.

Rudolph: We already make five sizes of our CPAP mask and our competitors may begin doing the same someday. The market needs more sizes, better fits, and more high quality masks to address the many face sizes and shapes throughout the world. RT

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