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A Journal on Diseases of the Respiratory System
Official Journal of the Italian Society of Thoracic Endoscopy
Indexed/Abstracted in: EMBASE, Scopus, Emerging Sources Citation Index
Minerva Pneumologica 2006 March;45(1):17-32
Non invasive ventilation in the treatment of obstructive sleep apnea syndrome: continuous positive airways pressure and more
Lacedonia D., Ardito M., Resta O.
Unità di malattie dell'Apparato Respiratorio Centro per i disturbi respiratori del sonno Dipartimento di Metodologia Clinicae Tecnologie Medico-Chirurgiche Università degli studi di Bari Facoltà di Medicina, Bari, Italia
Obstructive sleep apnea syndrome (OSAS) is characterized by repetitive obstruction of the upper airways often resulting in oxygen desaturation and arousal from sleep, excessive sleepiness and other consequences for health with an increase in morbility and mortality. Continuous positive airways pressure (CPAP) is currently considered to be the cornerstone of the therapy for OSAS. CPAP is immediately and consistently effective in relieving sleep apnea and daytime symptoms. CPAP reduces the incidence of accidents on the road, at work or at home, it is likely that CPAP has beneficial effects on daytime hypertension and that it reduces cardiovascular morbidity and mortality in the long term, but this has yet to be demonstrated unequivocally. The pressure should be titrated manually in the sleep laboratory during a full night of polysomnography, to eliminate apneas, hypopneas, snoring and sleep fragmentation, but it is possible use other strategies for titration. AutoCPAP (also called intelligent of self-adjusted CPAP) can be used for titration before switching to constant CPAP machine or can be used for long-term therapy. In the minority of OSAS patients requiring high levels of pressure or exhibiting chronic alveolar hypoventilation, clinical experience suggests that BiPAP could be of interest. Common difficulties associated with CPAP therapy include sense of dryness in the mouth, rhinorrhea, nasal congestion and mask discomfort, claustrophobia etc. Therefore, many patients are unable to or unwilling to comply with the use of CPAP, on this regard the various non-CPAP approaches are developed for the management of OSAS. A weight-reducing diet should be considered an important element not only as a treatment option, but also in the prevention and management of OSAS because obesity compromises airway function by altering pharyngeal size or geometry. Patients with OSAS should abstain from alcohol because it reduces the motor activity of the airway resistance and predispose to occlusion during sleep. Patients who use benzodiazepines, narcotics and barbiturates reported clinically significant upper way obstruction. The role of drug therapy in the treatment of OSAS is not well known. The 2 most extensively used pharmacological agents for treating OSAS have been medroxyprogesterone and the tricyclic antidepressant such us protriptiline. The use of oral appliance for the treatment of snoring and OSAS is relatively new field, with the result that there are many unanswered questions in this regard but it could be a reliable option for treating socially destructive snoring. Surgical management should be direct to the anatomic region involved and have specific goals for clearance at the respective obstruction levels. Presurgical evaluation for appreciation of the type of anatomic abnormality present and the degree of severity of OSAS is very important. However, none of these has been shown to be superior to CPAP. In the clinical practice, only selected patients will benefit from therapies other than CPAP.