Practice Parameters for the Use of Continuous and Bilevel Positive Airway Pressure Devices to Treat Adult Patients With Sleep-Related Breathing Disorders

Abstract

Positive airway pressure (PAP) devices are used to treat patients with sleep related breathing disorders (SRBD) including obstructive sleep apnea (OSA). Currently, PAP devices come in three forms: (1) continuous positive airway pressure (CPAP), (2) bilevel positive airway pressure (BPAP), and (3) automatic self-adjusting positive airway pressure (APAP). After a patient is diagnosed with OSA, the current standard of practice involves performing full, attended polysomnography during which positive pressure is adjusted to determine optimal pressure for maintaining airway patency. This titration is used to find a fixed single pressure for subsequent nightly usage. A task force of the Standards of Practice Committee of the American Academy of Sleep Medicine reviewed the available literature. Based on this review, the Standards of Practice Committee developed these practice parameters as a guideline for using CPAP and BPAP appropriately (an earlier review and practice parameters for APAP was published in 2002). Major conclusions and current recommendations are as follows: 1) A diagnosis of OSA must be established by an acceptable method. 2) CPAP is effective for treating OSA. 3) Full-night, attended studies performed in the laboratory are the preferred approach for titration to determine optimal pressure; however, split-night, diagnostic-titration studies are usually adequate. 4) CPAP usage should be monitored objectively to help assure utilization. 5) Initial CPAP follow-up is recommended during the first few weeks to establish utilization pattern and provide remediation if needed. 6) Longer-term follow-up is recommended yearly or as needed to address mask, machine, or usage problems. 7) Heated humidification and a systematic educational program are recommended to improve CPAP utilization. 8) Some functional outcomes such as subjective sleepiness improve with positive pressure treatment in patients with OSA. 9) CPAP and BPAP therapy are safe; side effects and adverse events are mainly minor and reversible. 10) BPAP may be useful in treating some forms of restrictive lung disease or hypoventilation syndromes associated with hypercapnia.

Recognizing and Managing Obstructive Sleep Apnea in Primary Care

“…There is currently no standard definition for the 34 and is recommended for the treatment of moderate to severe OSA and as an option for mild OSA (Figure 1). [35][36][37] The recommendations of the AASM also recognize that CPAP can improve quality of life and is an effective adjunct to lower blood pressure in patients with hypertension and OSA. 35 CPAP is adjusted to abolish apneas, hypopneas, and snoring and to diminish oxygen desaturation during all stages of sleep, thereby improving sleep quality.…”

“…[35][36][37] The recommendations of the AASM also recognize that CPAP can improve quality of life and is an effective adjunct to lower blood pressure in patients with hypertension and OSA. 35 CPAP is adjusted to abolish apneas, hypopneas, and snoring and to diminish oxygen desaturation during all stages of sleep, thereby improving sleep quality. CPAP has also been shown to improve ES, depression, cognitive function, quality of life, blood pressure, and some cardiovascular variables, although further studies are required.…”

Nasal inflammation in sleep apnoea patients using CPAP and effect of heated humidification

“…KEYWORDS: Continuous positive airway pressure, heated humidification, nasal obstruction, obstructive sleep apnoea N asal continuous positive airway pressure (CPAP) is considered the standard of care for treating moderate-to-severe obstructive sleep apnoea (OSA) [1]. Its use has been convincingly associated with substantial improvement in quality of life [2] and somnolence [3], along with significant benefits to cardiovascular morbidity and mortality [4,5].…”

Sleep-related breathing disorders and non-invasive ventilation

“…BIPAP is now proposed for the type of patients who require high expiratory pressures to control obstructive sleep apnea-hypopnea, but who cannot tolerate exhaling against a high-fixed CPAP pressure. 17 Other indications of BIPAP are the treatment of coexisting central apnea or hypoventilation, the obesity-hypoventilation syndrome, that cannot have a complete correction of the hypoxic state with CPAP only, the overlap syndrome and neuromuscular disorders. Although the patient should be able to maintain spontaneous breathing, it is used to set a back-up rate option for those patients whose ventilation during sleep may be particularly impaired (neuromuscular disorders, complex sleep apnea, central apnea in chronic heart failure, obesity-hypoventilation syndrome).…”

“…Although the patient should be able to maintain spontaneous breathing, it is used to set a back-up rate option for those patients whose ventilation during sleep may be particularly impaired (neuromuscular disorders, complex sleep apnea, central apnea in chronic heart failure, obesity-hypoventilation syndrome). 4,17 Average volume-assured pressure support ventilation Average volume-assured pressure support ventilation is used in patients with chronic hypoventilation and in particular with obesity hypoventilation syndrome, neuromuscular diseases, and sometimes, in chronic obstructive pulmonary disease. In this mode a target tidal volume is set; the device adjusts the pressure support to reach the set tidal volume.…”