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CPAP, BiPAP, APAP, ASV

https://www.ncbi.nlm.nih.gov/pubmed/22073075/

• Format: Abstract

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GMS Curr Top Otorhinolaryngol Head Neck Surg. 2006;5:Doc06. Epub 2006 Oct 5.

Selective indication for positive airway pressure (PAP) in sleep-related breathing disorders with obstruction.

Stasche N1.

Author information

Abstract

Positive airway pressure (PAP) is the therapy of choice for most sleep-related breathing disorders (SRBD). A variety of PAP devices using positive airway pressure (CPAP, BiPAP, APAP, ASV) must be carefully considered before application. This overview aims to provide criteria for choosing the optimal PAP device according to severity and type of sleep-related breathing disorder. In addition, the range of therapeutic applications, constraints and side effects as well as alternative methods to PAP will be discussed. This review is based on an analysis of current literature and clinical experience. The data is presented from an ENT-sleep-laboratory perspective and is designed to help the ENT practitioner initiate treatment and provide support. Different titration methods, current devices and possible applications will be described. In addition to constant pressure devices (CPAP), most commonly used for symptomatic obstructive sleep apnoea (OSA) without complicating conditions, BiPAP models will be introduced. These allow two different positive pressure settings and are thus especially suitable for patients with cardiopulmonary diseases or patients with pressure intolerance, increasing compliance in this subgroup considerably. Compliance can also be increased in patients during first night of therapy, patients with highly variable pressure demands or position-dependent OSA, by using self-regulating Auto-adjust PAP devices (Automatic positive airway pressure, APAP). Patients with Cheyne-Stokes breathing, a subtype of central sleep apnoea, benefit from adaptive servo-ventilation (ASV), which analyzes breathing patterns continually and adjusts the actual ventilation pressure accordingly. This not only reduces daytime sleepiness, but can also influence heart disease positively. Therapy with positive airway pressure is very effective in eliminating obstruction-related sleep diseases and symptoms. However, because therapy is generally applied for life, the optimal PAP device must be carefully selected, taking into account side effects that influence compliance.

KEYWORDS:

APAP; BiPAP; CPAP; indication; sleep apnea

Obstructive sleep apnoea syndrome and its management

The severity of obstructive sleep apnea (OSA) based on the apnea hypopnoea index (AHI).

	OSA severity
AHI < 5	Normal or primary snoring
5 < AHI < 20	Mild
20 < AHI < 40	Moderate
AHI > 40	Severe

Most common symptoms associated with obstructive sleep apnea.

Nocturnal	Diurnal
Snoring	Excessive sleepiness
Witnessed apnoeas	Morning headaches
Choking at night	Depression/irritability
Nicturia	Memory loss
Insomnia	Decreased libido

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4549693/


many patients can develop cognitive and neurobehavioral dysfunction, inability to concentrate, memory impairment and mood changes such as irritability and depression.

Insulin resistance, type II diabetes and altered serum lipid profile, widely described in patients with OSA, 

 Positive airway pressure (PAP), available since the beginning of the 1980s, provides the most effective and commonly used treatment. Alternative options include weight control, mandibular advancement devices and a number of upper airway surgical approaches.

 CPAP is highly effective in controlling symptoms, improving quality of life and reducing the clinical consequences of sleep apnoea and we must consider it as a first-line option. Bilevel PAP and Auto-CPAP can be used in those patients intolerant to CPAP or when high treatment pressures are necessary. Mandibular advancement devices can be offered as a viable alternative to patients with mild to moderate OSA, intolerant to PAP. The role of surgery remains controversial. Tonsillectomy and adenoidectomy are useful in children and in adults with enlarged tonsils. Uvulopalatopharyngoplasty is a well established procedure to be considered as a second-line option when PAP has failed. Maxillar mandibular surgery is extremely effective and can be suggested to patients with craniofacial malformations. All patients with obesity should be encouraged to lose weight and bariatric surgery can be considered in patients with BMI over 40. A multidisciplinary approach and the implementation of educational programs will significantly improve the management of the disease.