Nasal Positive Airway Pressure and Sleep Apnea. Reflections on an Experimental Method That Became a Therapy

Nasally applied continuous positive airway pressure (CPAP) therapy, acting as a pneumatic splint, is a remarkably effective treatment for obstructive sleep apnea (OSA), a therapy that rescues patients with life-threatening disease. By stabilizing the upper airway in sleep, nasal CPAP paved the way f...

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Bibliographic Details
Published in:American journal of respiratory and critical care medicine 2018-09, Vol.198 (5), p.581-587
Main Author: Sullivan, Colin E
Format: Article
Language:English
Subjects:
Administration, Intranasal
Airway management
Continuous positive airway pressure
Continuous Positive Airway Pressure - instrumentation
Continuous Positive Airway Pressure - methods
Experimental methods
Humans
Medical research
Oxygen therapy
Patients
Polysomnography
Research methodology
Respiratory failure
Sleep apnea
Sleep Apnea Syndromes - therapy
Telemedicine
Treatment Outcome
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Summary:Nasally applied continuous positive airway pressure (CPAP) therapy, acting as a pneumatic splint, is a remarkably effective treatment for obstructive sleep apnea (OSA), a therapy that rescues patients with life-threatening disease. By stabilizing the upper airway in sleep, nasal CPAP paved the way for the use of noninvasive positive pressure ventilation (NIPPV), now the standard of care in chronic hypercapnic respiratory failure. As a therapy, nasal CPAP has stood the test of time, remaining as the mainstay after 38 years. Beyond its role as a therapy, nasal CPAP as an experimental method continues to provide new insights. The discovery of sleep apnea, coupled with the advent of clinical oximetry, revealed a hidden pattern of respiratory failure characterized by repetitive falls and recovery in blood oxygen content that was previously unimaginable. The use of nasal CPAP in reversing this "experiment of nature" has enabled scientists to make numerous new discoveries in human subjects, revealing the diverse pathophysiology of the disorder across the whole spectrum of human biology, from integrated cardiorespiratory control, to hormonal and mediator function, to the cellular and genomic levels. Although the basic method has not changed, technological advances in the family of modern CPAP systems have greatly improved their usability and comfort. These systems integrate the diagnosis, treatment, and tools of ongoing management in a single unit, enabling better access for the many millions of sufferers to a life-transforming therapy.
ISSN:1073-449X
1535-4970
DOI:10.1164/rccm.201709-1921PP