Rethinking PAP
New ‘KPAP’ algorithm promises to make apnea therapy more usable
By Hannah Wolfson
The Tennessee-based company SleepRes burst onto the sleep therapy scene two years ago with the introduction of the V-Com, a small device that, when added to a standard CPAP, softens the peak inspiratory flow that often bothers new patients. Now its creator, the sleep physician William Noah, has come up with a new concept. At the end of May, he introduced the Kairos PAP (KPAP) algorithm, which he says allows CPAP pressure to be reduced to be more comfortable without impacting efficacy. HomeCare spoke with Noah about the new creation and how durable medical equipment (DME) providers might use it.
HomeCare: Can you briefly explain what KairosPAP or KPAP is and how it differs from traditional CPAP?
Noah: Kairos means “the right time” and was used by Hippocrates, the father of medicine, in 400 BCE to describe the right time of therapy. KPAP is therapy pressure only at the right time. The pressure is not continuous like CPAP or bilevel like BPAP or expiratory pressure release (EPR). KPAP allows us to reduce the pressure by 5 centimeters of water (cmH2O) during the other 80% of the breathing cycle to make breathing on KPAP more comfortable and more natural with less side effects (like treatment-emergent central sleep apnea) and still provide the same therapy. We sort of hide the pressure behind your breath.
It is a completely novel approach to therapy. Why should we expose patients to all this unnecessary pressure if there was no difference in efficacy?
HC: Is KPAP an entirely separate device, an add-on like the V-Com, or an adjustment to how existing CPAP devices function?
Noah: KPAP is an algorithm of pressure modulation that we can add to most any manufacturer’s device. It is an option on the device that does not have to be utilized, but most patients will obviously prefer it. In a recent blinded, randomized trial we found 94% preferred it to CPAP.
HC: How was KPAP developed?
Noah: A few years ago I set out to find a better way. I reviewed all the old literature and interviewed experts (especially engineers at the manufacturers). I also built my own research lab on my farm outside Nashville and started experiments. I tested most devices and masks made around the world. After three months, I made the first V-Com prototype. Then, 10 months later, I released it at the APSS 2022 (the annual meeting of the Associated Professional Sleep Societies) just to introduce the concept of reducing inspiratory pressure to the field.
By this time, I had KPAP in my head, but it needed development. I brought in who I thought were the best engineers in the field. It was the synergy of a sleep physician working daily with engineers exploring the possibilities. Then we used feedback from several hundred patients to find the optimal settings for comfort and efficacy. My goal was to find ways to improve the CPAP experience for my own patients. I never imagined I would find something so impactful.
HC: The best therapy in the world won’t help someone who won’t use it. How might moving to KPAP help with patient adherence to therapy?
Noah: Yes, much of adherence is behavioral, but KPAP should markedly increase acceptance. Pressure is the main deterrence, not the equipment. Beginning CPAP is an unnatural experience. By coincidence, I had two long-time Philips regional representatives visit me yesterday in my lab, who I let breathe on KPAP. They both described it as “more natural” and “like you aren’t even on CPAP.” As a sleep physician, when KPAP is available, I wouldn’t consider scripting a device without KPAP on it. Why make patients suffer from pressure that is unnecessary? I believe my peers will do the same.
HC: Is KPAP currently on the market and, if so, is it actually being prescribed by doctors and is it covered by private payers? How about by Medicare?
Noah: KPAP is expected on CPAP devices in the U.S. in 2025. It will be no different than billing current CPAP devices and should not cost more than other devices. Obviously, it will be covered by private payers and the Centers for Medicare & Medicaid Services. Right now, the V-Com, which drops inspiratory pressure by approximately 2 cmH2O, is available. Many patients use two V-Coms in their circuit and some use three.
HC: What do CPAP providers need to know about KPAP? How would they go about transitioning their patients to it?
Noah: KPAP is mainly for new patients beginning PAP therapy, but we believe most long-term users will prefer to have the KPAP option on their device. We found this to be true with the V-Com. So DMEs will just start ordering our devices with KPAP over the competitors. Plus, our cloud-based program for downloaded data will make managing patients a great experience for physicians and DMEs. The devices we are introducing to the U.S. market next year will be revolutionary in several other ways that I can’t announce right now.
We believe current devices were engineered from a wrong understanding of the airway and comfort. This will be the first PAP device in 30 years designed by sleep physicians, not just engineers, for sleep physicians to manage their patients. We are correcting mistakes of the past and introducing a whole new era in PAP technology. I believe the transition will be easy.
Hannah Wolfson is editor of HomeCare Media.
