Advanced Positive Airway Pressure Modalities

Abstract

Auto-adjusting positive airway pressure (PAP) devices are increasingly becoming the first line treatment for obstructive sleep apnea (OSA). More complex sleepdisordered breathing such as Cheyne-Stokes respirations and central sleep apnea related to heart failure as well as complex sleep-disordered breathing related to chronic hypoventilation syndromes may require the use of advanced positive airway pressure modalities such as automated servo ventilation (ASV) and volume targeted pressure limited ventilation. Identifying patients with complex sleep-disordered breathing that will benefit from treatment with advanced modalities remains an area of active investigation. A recent and surprising development found ASV to be associated with an increased risk of sudden cardiac death when used to treat central sleep apnea in patients with symptomatic systolic heart failure and an ejection fraction less than 45 %. The optimal treatment of central sleep apnea in heart failure and the role of ASV are currently in question. The following chapter is intended to provide the clinician with a description of newer PAP modalities; a review of evidence supported indications for use as well as provide a framework for managing patients with advanced positive airway pressure therapy.

The Effects of Changing Continuous Positive Airway Pressure Devices in Japanese Patients with Obstructive Sleep Apnea: A Case Series

“…In addition, each CPAP device has different designs and methodologies. The treatment efficacy and patient adherence differ widely among CPAP devices (4). However, to our knowledge, the effects of CPAP devices on OSA control and comfort in Japanese patients have not been reported.…”

“…Conversely, the device decreases the pressure until the flow limitation is detected while monitoring airway patency (4). The ResMed device uses forced oscillation of small pulses at 4 Hz and subsequent larger discrete test pulses to detect an open airway (4). The device also responds to flow limitation and apnea on a breath-by-breath basis (4).…”

“…The ResMed device uses forced oscillation of small pulses at 4 Hz and subsequent larger discrete test pulses to detect an open airway (4). The device also responds to flow limitation and apnea on a breath-by-breath basis (4).…”

“…Continuous positive airway pressure (CPAP) therapy is the gold standard for OSA treatment (3). However, different manufacturers have developed CPAP devices with specific power and algorithms unique to these devices (4). In addition, each CPAP device has different designs and methodologies.…”

Home- vs. Laboratory-Based Management Of OSA: An Economic Review

“…The American Academy of Sleep Medicine (AASM) recommends that HSAT only be used in patients with high pretest probability of moderate to severe disease without other significant medical or sleep related comorbidities under the guidance of a sleep specialist within a management pathway that uses PSG to confirm diagnosis when HSAT findings are inconclusive or negative [10]. Use of auto-titrating positive airway pressure (APAP) devices can also streamline management of OSA by obviating the need to perform attended PSG PAP titration in some OSA patients [11]. Studies have shown equivalent outcomes using APAP compared to manual PAP titration in appropriately selected patients; medically stable patients at high risk for moderate to severe OSA who do not have significant cardiorespiratory comorbidities [12][13][14][15][16].…”