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Minerva Pneumologica 2013 December;52(4):163-81

Copyright © 2013 EDIZIONI MINERVA MEDICA

language: English

Beyond CPAP-design and use of complex positive airway pressure devices in the treatment of obstructive sleep apnea

Wozniak D. R., Smith I.

Respiratory Support and Sleep Centre, Papworth Hospital, Cambridge, UK

Continuous positive airway pressure (CPAP) is the most frequently recommended and most effective treatment for moderate to severe obstructive sleep apnea (OSA) in those people who adhere to the therapy. Over the last three decades new modalities and modifications of positive airway pressure (PAP) have been developed, but have struggled to show convincing benefit in comparison to conventional CPAP. Auto-titrating positive airway pressure (APAP) has been validated in a number of trials and successfully introduced to routine practice. There are a number of distinct operating algorithms used in APAP devices, some of which can be utilized for unattended initiation of treatment. Pressure relief modifications are equivalent, but generally not superior to CPAP in tolerability and adherence to treatment. Bi-level PAP is useful in a subset of patients requiring high PAP or with concomitant hypoventilation. There is a need for more studies to ascertain the effectiveness and the place in clinical practice for nasal expiratory positive airway pressure devices (nEPAP) and the novel software aiming to differentiate sleep from wakefulness. Adaptive servo-ventilation (ASV) may treat complex sleep apnea effectively, but the selection of patients for this treatment and the optimum time of ASV initiation remain unclear. Further studies are needed to determine the role of these alternative modalities in subset of patients who struggle to persevere with treatment or suffer adverse effects of PAP. The impact of newer modalities, including APAP, on cardiovascular outcomes is unknown.