Improving patient tolerance of PAP is one of the main driving forces for the development of alternative modes of PAP. However, pressure intolerance is not a common complaint among PAP users, and a comparison between groups of consistent and intermittent CPAP users found no difference in the level of pressure. A change in PAP mode may dramatically improve adherence in individual patients. Symptoms of bloating, mouth leak, or pressure intolerance…
There are many side effects associated with PAP treatment” that if left untreated could lower the acceptance and adherence rates of PAP treatment. Common side effects and possible interventions are listed in Table 3. Involving both the patient and the spouse in the search for solutions to side effects (a team approach) is often helpful. The spouse may recognize mask or mouth leaks when the patient does not. Mask discomfort…
Some patients will exhibit significant arterial oxygen desaturation with PAP treatment despite apparently adequate airflow, especially during REM sleep. Persistent hypoxemia on PAP in these conditions may be due to hypoventilation or ven-tilation-perfusion mismatch (often due to chronic lung disease). Under such circumstances, PAP can be increased to eliminate unrecognized high upper airway resistance, or CPAP can be changed to bilevel PAP to augment ventilation (higher tidal volume). If these…
Attended polysomnography, which allows sleep stage, arousal, and body position determination, is the “gold standard” of PAP titration. The technologist can also address patient complaints, mask or mouth leaks, hypoxemia, or significant arrhythmias. Education about OSA and PAP, mask fitting, and a period of PAP acclimatization should be performed before lights out. Some of the common problems encountered during PAP titration and their solutions are listed in Table 2. PAP…
Untreated OSA increases the risk of being involved in a motor vehicle accident. Sassini and coworkers performed a metaanalysis of studies published prior to 2000 and found that untreated OSA was associated with a 2.5-fold increased risk. George examined the incidence of motor vehicle accidents in a group of 210 patients before and after treatment with nasal CPAP. A group of randomly selected drivers served as the control group. Untreated…
A number of studies have assessed the effect of CPAP on systemic hypertension. Becker and co-workers found that effective treatment of sleep apnea with nasal CPAP for > 9 weeks lowered both nocturnal and daytime systolic and diastolic BP by approximately 10 mm Hg. Strengths of this study included a longer duration of CPAP treatment and use of a noninvasive BP monitoring device that makes continuous measurements and is less…
Multiple effects of PAP treatment have been documented (Table 1). One can classify possible benefits from PAP treatment into four categories: (1) improvement of symptoms such as daytime sleepiness, disturbed sleep, impaired quality of life, or cognition; (2) reduced bed partner sleep disturbance or quality of life; (3) reduction of risk for cardiovascular disease, neurocognitive degeneration, or increased mortality associated with sleep apnea; and (4) reduction in the risk for…
CPAP delivers a predetermined constant pressure during both inspiration and exhalation (Fig 1). Bilevel PAP delivers a separately adjustable lower expiratory positive airway pressure (EPAP) and higher inspiratory positive airway pressure (IPAP). Bilevel PAP may be more tolerable than CPAP for some patients with difficulty exhaling. The IPAP-EPAP differential is useful for augmenting ventilation in patients with concomitant hypoventilation (“overlap syndrome” and obesity hypoventilation syndrome), and most physicians treat patients…
Since the original description of continuous positive airway pressure (CPAP) treatment by Sullivan and coworkers in 1983, positive airway pressure (PAP) remains the mainstay of treatment for mod-erate-to-severe obstructive sleep apnea (OSA) in adults. Despite many advances in technology, the major challenge facing clinicians is improving adherence to PAP treatment. A short review cannot provide in-depth coverage of the large amount of literature that has been published regarding the efficacy…
Given evidence from the Lung Health Study showing that smoking cessation “can have a substantial effect on subsequent mortality, even when successful in a minority of participants,” it has become imperative to offer smoking cessation services to all current smokers, especially those who are at highest risk. The elderly belong to this group. Paradoxically, they are often overlooked as prime target clients in such programs. Part of the reason lies…