Treatment of obstructive sleep-disordered breathing with positive airway pressure systems

• Published in: European respiratory review 2007-12, Vol.16 (106), p.125-131
• Main Authors: Pevernagie, D, Masa, J. F, Meurice, J. C, Farre, R, Marrone, O, Rodenstein, D
• Format: Article
• Language: English
• Subjects: Automatic continuous positive airway pressure; continuous positive airway pressure; sleep apnoea; sleep-disordered breathing
• ISSN: 0905-9180; 1600-0617
• DOI: 10.1183/09059180.00010603

* Dept of Respiratory Diseases and Sleep Medicine Centre, Ghent University Hospital, Ghent, Service de Pneumologie, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium, # Dept of Respiratory Diseases, San Pedro de Alcántara Hospital, Cáceres, Unitat de Biofisica i Bioenginyeria, Facultat de Medicina, Universitat de Barcelona-IDIBAPS, Barcelona, Spain, ¶ Service de Pneumologie, CHU de Poitiers, Poitiers, France, and Consiglio Nazionale delle Ricerche, Istituto di Biomedicina e Immunologia Molecolare, Palermo, Italy. CORRESPONDENCE: D. Pevernagie, Dept of Respiratory Diseases and Sleep Medicine Centre, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium. Fax: [phone]. E-mail: Dirk.Pevernagie{at}UGent.be Positive airway pressure systems are widely used to treat patients with moderate-to-severe obstructive sleep-disordered breathing. The application of stable continuous positive airway pressure (CPAP) via the nose (nasal CPAP) has been the mainstay of treatment since the early 1980s. For treatment to be effective, the pressure level must be fine-tuned to restore patency of the individual patient's upper airway. Currently, there is ongoing controversy concerning which outcomes to observe when adapting the pressure level, and which methods to use for pressure adaptation. Adjusting the pressure level to control apnoeas and hypopnoeas is one major objective, but may not be sufficient to restore normal sleep. Evidence is available that elimination of inspiratory flow limitation leads to better results. In recent years, it has become evident that the use of empirically set CPAP or automatic CPAP devices parallel the clinical results obtained with the classical approach of manual CPAP titration. A striking and still unexplained paradox lies in the fact that automatic CPAP devices perform very differently on the bench, but still yield satisfactory results on several clinical outcomes, e.g. control of sleep-related respiratory disturbances, restoration of good sleep quality and daytime alertness. Understanding the functioning of automatic CPAP devices can prove difficult, as the mode of operation is usually not disclosed by the manufacturers. At present, it is impossible to make any scientifically sound statement on the appropriateness of using automatic continuous positive airway pressure devices for the routine treatment of patients with obstructive sleep-disordered breathing. For this purpose, convincing results o