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Advances in Positive Pressure Therapy and Noninvasive Ventilation in the Treatment of Sleep Disorders

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Noninvasive Ventilation in Sleep Medicine and Pulmonary Critical Care

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Abstract

Introduction

Positive airway pressure (PAP) and non-invasive ventilation (NIV) are commonly used in the treatment of varied sleep disorders. While the efficacy of these devices at improving sleep-disordered breathing has been demonstrated, they may also improve other parameters of long-term health including cardiovascular and metabolic disorders. This paper reviews the most recent salient clinical trial and society guideline recommendations in relation to PAP and NIV treatment of sleep-disordered breathing.

Methodology

We searched PubMeb for articles between January 2017 and March 2019. We searched for different PAP and NIV modalities by name, different sleep disorders by name, and combinations thereof [e.g., CPAP, obstructive sleep apnea (OSA), and CPAP + OSA]. As well, we reviewed the most recent society guidelines with regard to PAP and NIV for sleep disorders.

Results

The original search resulted in 3110 articles published over this time period. Additional search limitations included the English language, clinical trials, and society guidelines. This decreased the number of articles to 161 which were reviewed for relevance, and ultimately 38 articles were selected.

Summary

Recent research in the field of PAP and NIV for the treatment of sleep disorders has looked at the benefits of therapy beyond the treatment of daytime sleepiness. Prospective randomized data is still lacking to show reduction in all-cause mortality and cardiovascular events in OSA treated with PAP, although observational data does show a reduction in all-cause mortality in treated severe OSA. Given the results of the SERVE-HF trial in 2015, a great deal of work is ongoing to elucidate the role of NIV in patients with concomitant heart failure and central sleep apnea. Additional studies have compared varied treatment modalities in patients with obesity hypoventilation with and without OSA. As well, new modes of ventilation offer promise for improved sleep parameters and compliance.

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Abbreviations

AASM:

American Academy of Sleep Medicine

AHI:

Apnea–hypopnea index

APAP:

Automatic positive airway pressure

ASV:

Adaptive servo-ventilation

BNP:

Brain natriuretic peptide

BPAP:

Bilevel positive airway pressure

CAD:

Coronary artery disease

CHF:

Congestive heart failure

CKD:

Chronic kidney disease

CMT:

Conservative medical therapy

COPD:

Chronic obstructive pulmonary disease

CPAP:

Continuous positive airway pressure

CSA:

Central sleep apnea

EF:

Ejection fraction

EPAP:

Expiratory positive airway pressure

mIBG:

I-metaiodobenzylguanidine

NIV:

Noninvasive ventilation

OHS:

Obesity hypoventilation syndrome

OSA:

Obstructive sleep apnea

PAP:

Positive airway pressure

PSG:

Polysomnogram

SDB:

Sleep-disordered breathing

T2D:

Type 2 diabetes mellitus

VAPS:

Volume-assured pressure support

References

  1. Patil SP, Ayappa IA, Caples SM, et al. Treatment of adult obstructive sleep apnea with positive airway pressure: an American academy of sleep medicine systematic review, meta-analysis, and grade assessment. J Clin Sleep. 2019;15(2):301–34.

    Article  Google Scholar 

  2. Glantz H, Johansson MC, Thunström E, et al. Effect of CPAP on diastolic function in coronary artery disease patients with nonsleepy obstructive sleep apnea: a randomized controlled trial. Int J Cardiol. 2017;241:12–8.

    Article  PubMed  Google Scholar 

  3. de Souza F, Muxfeldt ES, Margallo V, et al. Effects of continuous positive airway pressure treatment on aldosterone excretion in patients with obstructive sleep apnoea and resistant hypertension: a randomized controlled trial. J Hypertens. 2017;35(4):837–44.

    Article  PubMed  Google Scholar 

  4. Chang Y-S, Yee BJ, Hoyos CM, et al. The effects of continuous positive airway pressure therapy on troponin-T and N-terminal pro B-type natriuretic peptide in patients with obstructive sleep apnoea: a randomised controlled trial. Sleep Med. 2017;39:8–13.

    Article  PubMed  Google Scholar 

  5. Lam JCM, Lai AYK, Tam TCC, et al. CPAP therapy for patients with sleep apnea and type 2 diabetes mellitus improves control of blood pressure. Sleep Breath. 2017;21(2):377–86.

    Article  PubMed  Google Scholar 

  6. Morariu EM, Chasens ER, Strollo PJ, et al. Effect of continuous positive airway pressure (CPAP) on glycemic control and variability in type 2 diabetes. Sleep Breath. 2017;21(1):145–7.

    Article  PubMed  Google Scholar 

  7. Zhao YY, Wang R, Gleason KJ, et al. Effect of continuous positive airway pressure treatment on health-related quality of life and sleepiness in high cardiovascular risk individuals with sleep apnea: Best Apnea Interventions for Research (BestAIR) trial. Sleep. 2017; 40(4).

    Google Scholar 

  8. Yu J, Zhou Z, McEvoy RD, et al. Association of positive airway pressure with cardiovascular events and death in adults with sleep apnea: a systematic review and meta-analysis. JAMA. 2017;318(2):156–66.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Lisan Q, Van Sloten T, Marques Vidal P, et al. Association of positive airway pressure prescription with mortality in patients with obesity and severe obstructive sleep apnea: the sleep heart health study. JAMA Otolaryngol Head Neck Surg. 2019;145(6):509–15.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Campos-Rodriguez F, Gonzalez-Martinez M, Sanchez-Armengol A, et al. Effect of continuous positive airway pressure on blood pressure and metabolic profile in women with sleep apnoea. Eur Respir J. 2017; 50(2).

    Google Scholar 

  11. Luyster FS, Strollo PJ, Thunström E, et al. Long-term use of continuous positive airway pressure therapy in coronary artery disease patients with nonsleepy obstructive sleep apnea. Clin Cardiol. 2017;40(12):1297–302.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Randerath W, Bassetti CL, Bonsignore MR, et al. Challenges and perspectives in obstructive sleep apnoea: report by an ad hoc working group of the Sleep Disordered Breathing Group of the European Respiratory Society and the European Sleep Research Society. Eur Respir J. 2018;52(3).

    Google Scholar 

  13. Bloch KE, Huber F, Furian M, et al. Autoadjusted versus fixed CPAP for obstructive sleep apnoea: a multicentre, randomised equivalence trial. Thorax. 2018;73(2):174–84.

    Article  PubMed  Google Scholar 

  14. Marrone O, Cibella F, Pépin J-L, et al. Fixed but not autoadjusting positive airway pressure attenuates the time-dependent decline in glomerular filtration rate in patients with OSA. Chest. 2018;154(2):326–34.

    Article  PubMed  Google Scholar 

  15. Gagnadoux F, Pevernagie D, Jennum P, et al. Validation of the system one RemStar auto A-flex for obstructive sleep apnea treatment and detection of residual apnea-hypopnea index: a European randomized trial. J Clin Sleep Med. 2017;13(2):283–90.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Howard ME, Piper AJ, Stevens B, et al. A randomised controlled trial of CPAP versus non-invasive ventilation for initial treatment of obesity hypoventilation syndrome. Thorax. 2017;72(5):437–44.

    Article  PubMed  Google Scholar 

  17. Corral J, Mogollon MV, Sánchez-Quiroga M-Á, et al. Echocardiographic changes with non-invasive ventilation and CPAP in obesity hypoventilation syndrome. Thorax. 2018;73(4):361–8.

    Article  PubMed  Google Scholar 

  18. Masa JF, Mokhlesi B, Benítez I, et al. Long-term clinical effectiveness of continuous positive airway pressure therapy versus non-invasive ventilation therapy in patients with obesity hypoventilation syndrome: a multicentre, open-label, randomised controlled trial. Lancet. 2019;393(10182):1721–32.

    Article  PubMed  Google Scholar 

  19. Orfanos S, Jaffuel D, Perrin C, et al. Switch of noninvasive ventilation (NIV) to continuous positive airway pressure (CPAP) in patients with obesity hypoventilation syndrome: a pilot study. BMC Pulm Med. 2017;17(1):50.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Aurora RN, Chowdhuri S, Ramar K, et al. The treatment of central sleep apnea syndromes in adults: practice parameters with an evidence-based literature review and meta-analyses. Sleep. 2012;35(1):17–40.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Knitter J, Bailey OF, Poongkunran C, et al. Comparison of physiological performance of four adaptive servo ventilation devices in patients with complex sleep apnea. Am J Respir Crit Care Med. 2019;199(7):925–8.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Woehrle H, Cowie MR, Eulenburg C, et al. Adaptive servo ventilation for central sleep apnoea in heart failure: SERVE-HF on-treatment analysis. Eur Respir J. 2017;50(2).

    Google Scholar 

  23. O’Connor CM, Whellan DJ, Fiuzat M, et al. Cardiovascular outcomes with minute ventilation-targeted adaptive servo-ventilation therapy in heart failure: the CAT-HF trial. J Am Coll Cardiol. 2017;69(12):1577–87.

    Article  PubMed  Google Scholar 

  24. Yoshida M, Ando S-I, Kodama K, et al. Adaptive servo-ventilation therapy reduces hospitalization rate in patients with severe heart failure. Int J Cardiol. 2017;238:173–6.

    Article  PubMed  Google Scholar 

  25. Piccini JP, Pokorney SD, Anstrom KJ, et al. Adaptive servo-ventilation reduces atrial fibrillation burden in patients with heart failure and sleep apnea. Heart Rhythm. 2019;16(1):91–7.

    Article  PubMed  Google Scholar 

  26. Daubert MA, Whellan DJ, Woehrle H, et al. Treatment of sleep-disordered breathing in heart failure impacts cardiac remodeling: insights from the CAT-HF Trial. Am Heart J. 2018;201:40–8.

    Article  PubMed  Google Scholar 

  27. Hetland A, Lerum TV, Haugaa KH, et al. Patients with Cheyne–Stokes respiration and heart failure: patient tolerance after three-month discontinuation of treatment with adaptive servo-ventilation. Heart Vessels. 2017;32(8):909–15.

    Article  PubMed  Google Scholar 

  28. Hiasa G, Okayama H, Hosokawa S, et al. Beneficial effects of adaptive servo-ventilation therapy on readmission and medical costs in patients with chronic heart failure. Heart Vessels. 2018;33(8):859–65.

    Article  PubMed  Google Scholar 

  29. D’Elia E, Ferrero P, Vittori C, et al. Beneficial effects of adaptive servo-ventilation on natriuretic peptides and diastolic function in acute heart failure patients with preserved ejection fraction and sleep-disordered breathing. Sleep Breath. 2019;23(1):287–91.

    Article  PubMed  Google Scholar 

  30. Tokuda Y, Sakakibara M, Yoshinaga K, et al. Early therapeutic effects of adaptive servo-ventilation on cardiac sympathetic nervous function in patients with heart failure evaluated using a combination of 11C-HED PET and 123I-MIBG SPECT. J Nucl Cardiol. 2019;26(4):1079–89.

    Article  PubMed  Google Scholar 

  31. Toyama T, Hoshizaki H, Kasama S, et al. Adaptive servo-ventilation therapy improves cardiac sympathetic nerve activity, cardiac function, exercise capacity, and symptom in patients with chronic heart failure and Cheyne-Stokes respiration. J Nucl Cardiol. 2017;24(6):1926–37.

    Article  PubMed  Google Scholar 

  32. Gunn S, Naik S, Bianchi MT, et al. Estimation of adaptive ventilation success and failure using polysomnogram and outpatient therapy biomarkers. Sleep. 2018;41(9).

    Google Scholar 

  33. Berry RB, Chediak A, Brown LK, et al. Best clinical practices for the sleep center adjustment of noninvasive positive pressure ventilation (NPPV) in stable chronic alveolar hypoventilation syndromes. J Clin Sleep Med. 2010;6(5):491–509.

    Article  PubMed  Google Scholar 

  34. Royer CP, Schweiger C, Manica D, et al. Efficacy of bilevel ventilatory support in the treatment of stable patients with obesity hypoventilation syndrome: systematic review and meta-analysis. Sleep Med. 2019;53:153–64.

    Article  PubMed  Google Scholar 

  35. Huang XA, Du YP, Li LX, et al. Comparing the effects and compliance between volume-assured and pressure support non-invasive ventilation in patients with chronic respiratory failure. Clin Respir J. 2019;13(5):289–98.

    Article  PubMed  Google Scholar 

  36. McArdle N, Rea C, King S, et al. Treating chronic hypoventilation with automatic adjustable versus fixed EPAP intelligent volume-assured positive airway pressure support (iVAPS): a randomized controlled trial. Sleep. 2017;40(10).

    Google Scholar 

  37. Zou C, Sheng W, Huai D, et al. Comparison between auto-trilevel and bilevel positive airway pressure ventilation for treatment of patients with concurrent obesity hypoventilation syndrome and obstructive sleep apnea syndrome. Sleep Breath. 2019;23(3):735–40.

    Article  PubMed  Google Scholar 

  38. Su M, Huai D, Cao J, et al. Auto-trilevel versus bilevel positive airway pressure ventilation for hypercapnic overlap syndrome patients. Sleep Breath. 2018;22(1):65–70.

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. David Geffen School of Medicine, Los Angeles, CA, USA

    William B. LeMaster, Armand Ryden, Melisa Chang & Michelle Zeidler

  2. Greater Los Angeles VA, Los Angeles, CA, USA

    William B. LeMaster, Armand Ryden, Melisa Chang & Michelle Zeidler

Authors
  1. William B. LeMaster
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  2. Armand Ryden
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  3. Melisa Chang
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  4. Michelle Zeidler
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Corresponding author

Correspondence to Michelle Zeidler .

Editor information

Editors and Affiliations

  1. Intensive Care Unit, Hospital General Universitario Morales Meseguer, Murcia, Spain

    Antonio M. Esquinas

  2. Department of Pathophysiology and Pulmonary Rehab, Azienda Ospedaliera dei Colli PO Monaldi, Napoli, Italy

    Giuseppe Fiorentino

  3. Innovative Technologies for the Study of Sleep Breathing Disorders, Institute for Biomedical Research and Innovation (IRIB), Italian National Research Council, Palermo, Italy

    Giuseppe Insalaco

  4. Department of Pulmonary and CC Medicine, Lenox Hill Hospital, New York, NY, USA

    Bushra Mina

  5. Department of Respiratory and CC Medicine, First Affiliated Hospital of Chongqing M, Chongqing, China

    Jun Duan

  6. Anestesia and Pediatric Intensive Care Department, University Hospital Policlinico S. Orsola-Malpighi, Bologna, Italy

    Maria Cristina Mondardini

  7. Anestesia and Pediatric Intensive Care Department, University Hospital Policlinico S. Orsola-Malpighi, Bologna, Italy

    Fabio Caramelli

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LeMaster, W.B., Ryden, A., Chang, M., Zeidler, M. (2020). Advances in Positive Pressure Therapy and Noninvasive Ventilation in the Treatment of Sleep Disorders. In: Esquinas, A.M., et al. Noninvasive Ventilation in Sleep Medicine and Pulmonary Critical Care. Springer, Cham. https://doi.org/10.1007/978-3-030-42998-0_26

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  • DOI: https://doi.org/10.1007/978-3-030-42998-0_26

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-42997-3

  • Online ISBN: 978-3-030-42998-0

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