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Semin Respir Crit Care Med 2005; 26(1): 68-79
DOI: 10.1055/s-2005-864209
Published 2005 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Positive Airway Pressure Therapy of OSA

Max Hirshkowitz1 , 2 , 3 , 4 , Amir Sharafkhaneh2 , 3 , 4
  • 1Departments of Psychiatry, Houston, Texas
  • 2Medicine, Baylor College of Medicine, Houston, Texas
  • 3Houston VAMC Sleep Center, Houston, Texas
  • 4Methodist Hospital Sleep Diagnostic Laboratory, Houston, Texas
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Publication History

Publication Date:
22 February 2005 (online)

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ABSTRACT

Positive airway pressure is standard therapy for patients with obstructive sleep apnea. It comes in three basic varieties: (1) continuous positive airway pressure (CPAP), (2) bilevel positive airway pressure (BPAP), and (3) autotitrating positive airway pressure (APAP). When properly titrated, positive airway pressure devices minimize the number of sleep-related breathing disorder events, often producing dramatic results. Sleep-related breathing may completely normalize, specific stages of sleep may selectively rebound due to having been chronically suppressed, sleep microstructure may improve, and the patient may awaken feeling refreshed for the first time in years. The specific indications and criteria for recommending APAP, BPAP, and CPAP therapy are reviewed. The titration process is presented in a step-by-step manner and titration grading is explained. Issues surrounding the interface, acceptance, utilization, and side-effects are discussed. Finally, we present an assortment of approaches for troubleshooting clinical problems commonly encountered among patients being treated with positive airway pressure therapy.

KEYWORDS

Sleep apnea - continuous positive airway pressure - bilevel positive airway pressure - autotitrating positive airway pressure

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Max HirshkowitzPh.D. 

VAMC Sleep Center 111i, 2002 Holcombe Blvd.

Houston, TX 77030

Email: maxh@bcm.tmc.edu