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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 2011 March;50(1):5-16
Continuous positive airway pressure
Randerath W. J.
Institute of Pneumology at the University Witten/Herdecke, Clinic for Pneumology and Allergology, Center of Sleep Medicine and Respiratory Care, Bethanien Hospital, Solingen, Germany
The obstructive sleep apnea syndrome (OSAS) represents not only a highly relevant health problem for individuals but also a socioeconomic challenge for societies due to its huge prevalence, the increased risk of accidents on the road and in the workplace and cardiovascular sequelae. Obstructive apneas and hypopneas are characterized by intermittent cessations or reductions of the airflow through nose and mouth while the thoracic and abdominal breathing efforts remain active. The pathophysiology of the upper airway collapse includes anatomical narrowing of the airways due to skeletal malformations and enlargement of the tongue or lateral pharyngeal walls associated with obesity. Moreover, the dysfunction of the upper airway muscles plays a crucial role in the development of obstructive breathing disturbances. The application of continuous positive airway pressure (CPAP) has become the treatment of choice of obstructive sleep apnea. It has been proven to normalize respiratory disturbances during sleep, improve neurocognitive deficits, and reduce the risk of accidents and of cardiovascular consequences. Automatic positive airway pressure (APAP) and bi-level pressure treatment are modifications of CPAP. They have shown to be equally effective but not superior to CPAP in general. However, these modifications might be more effective in those difficult to treat patients in whom CPAP has failed. Most recently, inspiratory pressure relief and automatic trilevel – which combines bi-level, pressure relief and automatic pressure adjustment – have been introduced.