Positive Airway Pressure in the Treatment of Sleep-Related Breathing Disorders

Abstract

Continuous positive airway pressure (CPAP) is currently the medical therapy of choice for patients with Obstructive Sleep Apnea/Hypopnea (OSA/H). CPAP application during sleep virtually always provides adequate upper airway patency and acceptable oxyhemoglobin saturation during sleep and usually improves sleep continuity. This results in improved daytime alertness, function, and quality of life. Preliminary data suggest that CPAP therapy also reduces systemic and pulmonary artery blood pressure and alleviates cardiac ischemia associated with nocturnal oxyhemoglobin desaturation. Patient compliance with CPAP therapy is often incomplete, however. Although average daily use of CPAP is generally between 4 and 6 hours, there is great interindividual variability with greatest compliance in patients with the highest pretreatment subjective sleepiness and functional impairment. Evolving improvements in mask interfaces may improve patient acceptance and compliance. In addition, ongoing developments such as bilevel positive pressure and autotitrating CPAP devices that are designed to reduce the pressure required to maintain adequate upper airway patency during sleep may improve acceptance and compliance in some patients.

Key Words:

sleep apnea - continuous positive airway pressure - sleep-disordered breathing - polysomnography