Proportional positive airway pressure: a new concept to treat obstructive sleep apnoea

Abstract

Proportional positive airway pressure (PPAP) was designed to optimize airway pressure for the therapy of obstructive sleep apnoea (OSA). In a randomized crossover prospective study, the clinical feasibility of PPAP and its immediate effects on the breathing disorder and sleep in comparison with continuous positive airway pressure (CPAP) was evaluated. Twelve patients requiring CPAP therapy underwent CPAP and PPAP titration in a random order.Obstructive and mixed respiratory events could be completely abolished with both forms of treatment. This ef®cacy could be achieved at a signi®cantly lower mean mask pressure during PPAP titration (8.452.42 cmH 2 O) compared to CPAP (9.962.7 cmH 2 O) (p=0.002). The mean minimal arterial oxygen saturation (Sa,O 2 ) (82.86.5%) on the diagnostic night increased signi®cantly (p<0.001) to an average Sa,O 2 of 93.351. 71% and 93.192.9% during CPAP and PPAP titration. Total sleep time, slow wave sleep and rapid eye movement (REM) sleep increased signi®cantly by the same amount during both CPAP and PPAP titration (p<0.001), while sleep stage nonrapid eye movement (NREM) 1 and 2 decreased. Six patients preferred the PPAP titration night, four patients did not have a preference, and two patients preferred CPAP.The present data show that proportional positive airway pressure is as effective as continuous positive airway pressure in eliminating obstructive events and has the same immediate effect on sleep. The lower average mask pressure during proportional positive airway pressure implies potential advantages compared to continuous positive airway pressure. Proportional positive airway pressure presents a new effective therapeutic approach to obstructive sleep apnoea.

Comparison of three auto-adjusting positive pressure devices in patients with sleep apnoea

“…Some previous reports have indicated a preference towards APAP in treatment-naive patients [23,24], whereas others have reported no such preference [25,26]. However, the present study design was specifically chosen to directly compare these three APAP devices, an objective that would have been more difficult in treatment-naive patients.…”

Clinical Guidelines for the Manual Titration of Positive Airway Pressure in Patients with Obstructive Sleep Apnea

“…These new technologies have had limited testing but have potential utility in patient acceptance and utilization of PAP. 43,58,[96][97][98][99] This recommendation is based on consensus agreement by the PAP Titration Task Force. Optimal CPAP has been defined as the highest pressure obtained during REM sleep with the patient having slept in the supine position.…”

Clinical Approach to Patients with COVID-19 and Unrecognized Obstructive Sleep Apnea

“…This prevents the collapse of throat tissues and maintains uninterrupted breathing throughout the night. The goal of CPAP is to provide a base pressure to overcome static collapsing forces (dependent on the position, skeletal structure, shape and tone of airway tissue), while compensating for variable collapsing forces (dependent on respiratory efforts and flow effects) [9]. The application of CPAP can also decrease atelectasis, increase the surface area of the alveoli, improve ventilation/perfusion matching and oxygenation, as well as ensuring the maintenance of functional residual capacity [10].…”