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Positive Pressure Therapy for OSA

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Primary Care Sleep Medicine

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Abstract

Positive airway pressure therapy is the most effective and immediate treatment for obstructive sleep apnea (OSA) other than tracheotomy. Over the period of more than 30 years it has been available, there have been continued improvements in design leading to greater comfort and acceptance. Newer forms of therapy including bilevel pressure and automated devices may be advantageous in some circumstances. Finding the best CPAP pressure usually involves in laboratory titration to eliminate inspiratory flow limitation. A “split-night” diagnostic and therapeutic protocol may be successful in many but not all cases. Recent studies have examined the effects of treatment on sleepiness, cognitive impairment, and affect with generally positive results. There is also evidence that treatment with positive airway pressure helps to reduce hypertension, atherosclerosis, risk of recurrent atrial fibrillation, and risk of stroke. Optimal treatment includes careful attention to choice of interface and objective monitoring of compliance.

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References

  1. Sullivan C, Issa F, Berthon-Jones M, et al. Reversal of obstructive sleep apnea by continuous positive airway pressure applied through the nares. Lancet. 1981;1:862–5.

    Article  CAS  PubMed  Google Scholar 

  2. Center for Medicare and Medicaid Services. Pub 100–03, Medicare National Coverage Determinations. Continuous Positive Airway Pressure (CPAP) Therapy for Obstructive Sleep Apnea (OSA) (Effective 13 March 2008).

    Google Scholar 

  3. Kushida CA, Chediak A, Berry RB, Brown LK, Gozal D, Iber C, Parthasarathy S, Quan SF, Rowley JA, Positive Airway Pressure Titration Task Force of the American Academy of Sleep Medicine. Clinical guidelines for the manual titration of positive airway pressure in patients with obstructive sleep apnea. J Clin Sleep Med. 2008;4(2):157–71.

    PubMed  Google Scholar 

  4. Montserrat JM, Ballester E, Olivi H, et al. Time-course of stepwise CPAP titration. Behavior of respiratory and neurologic variables. Am J Respir Crit Care Med. 1995;152:1854–9.

    Article  CAS  PubMed  Google Scholar 

  5. Somiah M, Taxin Z, Keating J, Mooney AM, Norman RG, Rapoport DM, Ayappa I. Sleep quality, short-term and long-term CPAP adherence. J Clin Sleep Med. 2012;8(5):489–500.

    PubMed Central  PubMed  Google Scholar 

  6. Lettieri CJ, Collen JF, Eliasson AH, Quast TM. Sedative use during continuous positive airway pressure titration improves subsequent compliance: a randomized, double-blind, placebo-controlled trial. Chest. 2009;136:1263–8.

    Article  PubMed  Google Scholar 

  7. McArdle N, Grove A, Devereux G, et al. Split-night versus full-night studies for sleep apnoea/hypopnea syndrome. Eur Resp J. 2000;15:670–5.

    Article  CAS  Google Scholar 

  8. Sanders MH, Costantino JP, Strollo PJ, et al. The impact of split-night polysomnography for diagnosis and positive pressure therapy titration on treatment acceptance and adherence in sleep apnea/hypopnea. Sleep. 2000;23:17–24.

    Google Scholar 

  9. Gay PC, Herold DL, Olson EJ. A randomized, double-blind clinical trial comparing continuous positive airway pressure with a novel bilevel pressure system for treatment of obstructive sleep apnea syndrome. Sleep. 2003;26:864–9.

    PubMed  Google Scholar 

  10. Blau A, Minx M, Decker B, et al. Respiration and sleep in OSA patients treated with CPAP vs. auto bilevel pressure relief-pap. Sleep. 2008;31:A191.

    Google Scholar 

  11. Schafer H, Ewig S, Hasper E, Luderitz B. Failure of CPAP therapy in obstructive sleep apnoea syndrome: predictive factors and treatment with bilevel-positive airway pressure. Respir Med. 1998;92:208–15.

    Article  CAS  PubMed  Google Scholar 

  12. Ballard RD, Gay PC, Strollo PJ. Interventions to improve compliance in sleep apnea patients previously non-compliant with continuous positive airway pressure. J Clin Sleep Med. 2007;3:706–12.

    PubMed Central  PubMed  Google Scholar 

  13. Schwartz SW, Rosas J, Iannacone MR, et al. Correlates of a prescription for bilevel positive airway pressure for treatment of obstructive sleep apnea among veterans. J Clin Sleep Med. 2013;9(4):327–35.

    PubMed Central  PubMed  Google Scholar 

  14. Morgenthaler TI, Aurora RN, Brown T, Standards of Practice Committee of the AASM, et al. Practice parameters for the use of autotitrating continuous positive airway pressure devices for titrating pressures and treating adult patients with obstructive sleep apnea syndrome: an update for 2007. Sleep. 2008;31(1):141–7.

    PubMed Central  PubMed  Google Scholar 

  15. McArdle N, Singh B, Murphy M, et al. Continuous positive airway pressure titration for sleep apnoea: automatic versus manual titration. Thorax. 2010;65:606–11.

    Article  PubMed  Google Scholar 

  16. Kushida CA, Berry RB, Blau A, Crabtree T, Fietze I, Kryger MH, Kuna ST, Pegram GV, Penzel T. Positive airway pressure initiation: a randomized controlled trial to assess the impact of therapy mode and titration process on efficacy, adherence, and outcomes. Sleep. 2010;34(8):1083–92.

    Google Scholar 

  17. Massie CA, McArdle N, Hart RW, et al. Comparison between automatic and fixed positive airway pressure therapy in the home. Am J Respir Crit Care Med. 2003;167:20–3.

    Article  PubMed  Google Scholar 

  18. Masa JF, Jimenez A, Duran J, et al. Alternative methods of titrating continuous positive airway pressure. Am J Respir Crit Care Med. 2004;170:1218–24.

    Article  PubMed  Google Scholar 

  19. Chai CL, Pathinathan A, Smith BJ. Continuous positive airway pressure delivery interfaces for obstructive sleep apnoea. Cochrane Database of Syst Rev. 2006; Issue 4. Art. No.: CD005308. Doi: 10.1002/14651858.CD005308.pub2.

    Google Scholar 

  20. Bakker J, Campbell A, Neill A. Randomized controlled trial comparing flexible and continuous positive airway pressure delivery: effects on compliance, objective and subjective sleepiness and vigilance. Sleep. 2010;33(4):523–9.

    PubMed Central  PubMed  Google Scholar 

  21. Wenzel M, Kerl J, Dellweg d. Expiratory pressure reduction (C-Flex method) versus fix CPAP in the therapy for obstructive sleep apnoea. Pneumologie. 2007;61:692–5.

    Article  CAS  PubMed  Google Scholar 

  22. George CF. Reduction in motor vehicle collisions following treatment of sleep apnoea with nasal CPAP. Thorax. 2001;56:508–12.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  23. Turkington PM, Sircar M, Saralaya D, Elliott MW. Time course of changes in driving simulator performance with and without treatment in patients with sleep apnoea hypopnea syndrome. Thorax. 2004;59:56–9.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  24. Weaver TE, Maislin G, Dinges DF, et al. Relationship between hours of CPAP use and achieving normal levels of sleepiness and daily functioning. Sleep. 2007;30(6):711–9.

    PubMed Central  PubMed  Google Scholar 

  25. Veasey S, Davis C, Fenik P, et al. Long-term intermittent hypoxia in mice: protracted hypersomnolence with oxidative injury to sleep-wake brain regions. Sleep. 2004;27:194–201.

    PubMed  Google Scholar 

  26. Canessa N, Castronovo V, Cappa SF, et al. Obstructive sleep apnea: brain structural changes and neurocognitive function before and after treatment. Am J Respir Crit Care Med. 2011;183:1419–26.

    Article  PubMed  Google Scholar 

  27. Antic NA, Catcheside P, Buchan C, Hensley M, Naughton MT, Rowland S, Williamson B, Windler S, McEvoy RD. The effect of CPAP in normalizing daytime sleepiness, quality of life, and neurocognitive function in patients with moderate to severe OSA. Sleep. 2011;34(1):111–9.

    PubMed Central  PubMed  Google Scholar 

  28. Kushida CA, Nichols DA, Holmes TH, et al. Effects of continuous positive airway pressure on neurocognitive function in obstructive sleep apnea patients: the Apnea Positive Pressure Long-term Efficacy Study (APPLES). Sleep. 2012;35(12):1593–602.

    PubMed Central  PubMed  Google Scholar 

  29. Black J, Hirshkowitz M. Modafinil for the treatment of residual excessive sleepiness in nasal CPAP treated obstructive sleep apnea/hypopnea syndrome. Sleep. 2005;28:464–71.

    PubMed  Google Scholar 

  30. Mendelson W. Depression in sleep apnea patients. Sleep Res. 1992;21:230.

    Google Scholar 

  31. Mosko S, Zetin M, Glen S, et al. Self-reported depressive symptomatology, mood ratings and treatment outcome in sleep disorders. J Clin Psychol. 1989;45:51–60.

    Article  CAS  PubMed  Google Scholar 

  32. Giles TL, Lasserson TJ, Smith BJ, White J, Wright J, Cates CJ. Continuous positive airways pressure for obstructive sleep apnoea in adults. Cochrane Database Syst Rev. 2006; Issue 1. Art. No.: CD001106.

    Google Scholar 

  33. Shahar E, Whitney CW, Redline S, et al. Sleep-disordered breathing and cardiovascular disease. Am J Resp Crit Care Med. 2001;163:19–25.

    Article  CAS  PubMed  Google Scholar 

  34. Alajmi M, Mulgrew AT, Fox J, et al. Impact of CPAP therapy on blood pressure in patients with obstructive sleep apnea hypopnea: a meta-analysis of randomized clinical trials. Lung. 2007;185(2):67–72.

    Article  CAS  PubMed  Google Scholar 

  35. Pedrosa RP, Drager LF, Gonzaga CC, et al. Obstructive sleep apnea: the most common secondary cause of hypertension associated with resistant hypertension. Hypertension. 2011;58(5):811–7.

    Article  CAS  PubMed  Google Scholar 

  36. Martinez-Garcia M-A, Capote F, Campos-Rodriguez F, et al. Effect of CPAP on blood pressure in patients with obstructive sleep apnea and resistant hypertension, the HIPARCO trial. JAMA. 2013;310(22):2407–15.

    CAS  PubMed  Google Scholar 

  37. Pedrosa RP, Drager LF, dePaula LKG, et al. Effects of OSA treatment on BP in patients with resistant hypertension, a randomized trial. Chest. 2013;144(5):1487–94.

    Article  CAS  PubMed  Google Scholar 

  38. Drager LF, Bortolotto LA, Figueiredo AC, et al. Effects of CPAP on early signs of atherosclerosis in OSA. Am J Resp Crit Care Med. 2007;176:706–12.

    Article  CAS  PubMed  Google Scholar 

  39. Sharma SK, Agarwal S, Damodaran D, et al. CPAP for the metabolic syndrome in patients with obstructive sleep apnea. N Engl J Med. 2011;365(24):2277–86.

    Article  CAS  PubMed  Google Scholar 

  40. Marin JM, Carrizo SJ, Vicente E, et al. Long-term cardiovascular outcomes in men with or without treatment with CPAP: an observational study. Lancet. 2005;365(9464):1046–53.

    Article  PubMed  Google Scholar 

  41. Ryan CM, Bayley M, Green R, et al. Influence of CPAP on outcomes of rehabilitation in stroke patients with OSA. Stroke. 2011;42(4):1062–7.

    Article  PubMed  Google Scholar 

  42. Abe H, Takahashi M, Yaegashi H, et al. Efficacy of continuous positive airway pressure on arrhythmias in obstructive sleep apnea patients. Heart Vessels. 2010;25:63–9.

    Article  PubMed  Google Scholar 

  43. Kanagala R, Murali NS, Friedman PA, et al. Obstructive sleep apnea and the recurrence of atrial fibrillation. Circulation. 2003;107:2589–94.

    PubMed  Google Scholar 

  44. Fein AS, Shvilkin A, Shah D, et al. Treatment of obstructive sleep apnea reduces the risk of atrial fibrillation recurrence after catheter ablation. J Am Coll Cardiol. 2013;62(4):300–5.

    Article  PubMed  Google Scholar 

  45. McArdle N, Devereux G, Hedarnejad H, et al. Long term use of CPAP therapy for sleep apnea/hypopnea syndrome. Am J Respo Crit Care Med. 1999;159:1108–14.

    Article  CAS  Google Scholar 

  46. Weaver T, Kribbs N, Pack A, et al. Night to night variability in CPAP use over the first three months of treatment. Sleep. 1997;20:278–83.

    CAS  PubMed  Google Scholar 

  47. Lewis K, Seale L, Bartle I, et al. Early predictors of CPAP use for the treatment of obstructive sleep apnea. Sleep. 2004;27:134–8.

    PubMed  Google Scholar 

  48. Schwab RJ, Badr SM, Epstein LJ, et al. An official American Thoracic Society statement: CPAP adherence tracking systems. Am J Resp Crit Care Med. 2013;188(5):613–20.

    Article  PubMed  Google Scholar 

  49. Kribbs NB, Pack AJ, Kline LR, et al. Effects of one night without nasal CPAP treatment on sleep and sleepiness in patients with obstructive sleep apnea. Am Rev Resp Dis. 1993;147:1162–8.

    Article  CAS  PubMed  Google Scholar 

  50. Yang Q, Phillips CL, Melehan KL, et al. Effects of short-term CPAP withdrawal on neurobehavioral performance in patients with obstructive sleep apnea. Sleep. 2006;29:545–52.

    PubMed  Google Scholar 

  51. Young LR, Taxin ZH, Norman RG, Walsleben JA, Rapoport DM, Ayappa I. Response to CPAP withdrawal in patients with mild versus severe obstructive sleep apnea/hypopnea syndrome. Sleep. 2013;36(3):405–12.

    PubMed Central  PubMed  Google Scholar 

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Authors and Affiliations

  1. Center for Sleep Medicine, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Place, New York, NY, 10029, USA

    Steven H. Feinsilver M.D., F.C.C.P.

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  1. Steven H. Feinsilver M.D., F.C.C.P.
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Correspondence to Steven H. Feinsilver M.D., F.C.C.P. .

Editor information

Editors and Affiliations

  1. Sleep Disorders Center, Pueblo, Colorado, USA

    James F. Pagel

  2. Department of Population Health, New York University School of Medicine / Center for Healthful Behavior Change, New York, New York, USA

    S. R. Pandi-Perumal

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Feinsilver, S.H. (2014). Positive Pressure Therapy for OSA. In: Pagel, J., Pandi-Perumal, S. (eds) Primary Care Sleep Medicine. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-1185-1_16

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  • DOI: https://doi.org/10.1007/978-1-4939-1185-1_16

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