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Management of Sleep Disorders: CPAP (Continuous Positive Airway Pressure)

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Introduction to Modern Sleep Technology

Part of the book series: Intelligent Systems, Control and Automation: Science and Engineering ((ISCA,volume 64))

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Abstract

Continuous positive airway pressure (CPAP) is a positive airway pressure (PAP) device that is commonly used to treat sleep disordered breathing (SDB) such as obstructive sleep apnea (OSA). CPAP helps to correct SDB by acting as a passive pneumatic splint for the upper airway and increasing lung volume to exert pharyngeal caudal traction, thereby stiffening the upper airway and reducing collapsibility. Despite its well-known benefits in treating SDB, overall adherence with CPAP is low, predominantly due to its side effects. Side effects are related to the pressure from CPAP (such as rhinitis and mouth dryness), the use of mask interfaces (such as claustrophobia and skin breakdown), and the machine (such as the noise and condensation). Recent advances in technology have led to the development of pressure relief mechanisms (such as C-flex® and EPR®) and auto-adjusting (APAP) machines. Pressure relief mechanisms help by reducing pressure during early exhalation, while APAP might help by reducing the mean optimal pressure required to treat SDB, thereby reducing pressure related side effects. Despite technological advances and efficacy of these devices to control SDB compared to the fixed pressure with CPAP, studies have not conclusively shown improvement in adherence.

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References

  1. Horner RL, Innes JA, Murphy K, Guz A (1991) Evidence for reflex upper airway dilator muscle activation by sudden negative airway pressure in man. J Physiol 436:15–29

    Google Scholar 

  2. Series F (2002) Upper airway muscles awake and asleep. Sleep Med Rev 6(3):229–242

    Article  Google Scholar 

  3. Patil SP, Schneider H, Marx JJ, Gladmon E, Schwartz AR, Smith PL (2007) Neuromechanical control of upper airway patency during sleep. J Appl Physiol 102(2):547–556

    Article  Google Scholar 

  4. Burger CD, Stanson AW, Sheedy PF 2nd, Daniels BK, Shepard JW Jr (1992) Fast-computed tomography evaluation of age-related changes in upper airway structure and function in normal men. Am Rev Respir Dis 145(4 Pt 1):846–852

    Google Scholar 

  5. Haponik EF, Smith PL, Bohlman ME, Allen RP, Goldman SM, Bleecker ER (1983) Computerized tomography in obstructive sleep apnea. Correlation of airway size with physiology during sleep and wakefulness. Am Rev Respir Dis 127(2):221–226

    Google Scholar 

  6. Schwab RJ, Gupta KB, Gefter WB, Metzger LJ, Hoffman EA, Pack AI (1995) Upper airway and soft tissue anatomy in normal subjects and patients with sleep-disordered breathing. Significance of the lateral pharyngeal walls. Am J Respir Crit Care Med 152(5 Pt 1):1673–1689

    Google Scholar 

  7. Mezzanotte WS, Tangel DJ, White DP (1992) Waking genioglossal electromyogram in sleep apnea patients versus normal controls (a neuromuscular compensatory mechanism). J Clin Invest 89(5):1571–1579

    Article  Google Scholar 

  8. Mezzanotte WS, Tangel DJ, White DP (1996) Influence of sleep onset on upper-airway muscle activity in apnea patients versus normal controls. Am J Respir Crit Care Med 153(6 Pt 1):1880–1887

    Google Scholar 

  9. Worsnop C, Kay A, Pierce R, Kim Y, Trinder J (1998) Activity of respiratory pump and upper airway muscles during sleep onset. J Appl Physiol 85(3):908–920

    Google Scholar 

  10. Pillar G, Fogel RB, Malhotra A, Beauregard J, Edwards JK, Shea SA, White DP (2001) Genioglossal inspiratory activation: central respiratory vs mechanoreceptive influences. Respir Physiol 127(1):23–38

    Article  Google Scholar 

  11. Guilleminault C, Ramar K (2009) Neurologic aspects of sleep apnea: is obstructive sleep apnea a neurologic disorder? Semin Neurol 29(4):368–371

    Article  Google Scholar 

  12. Boyd JH, Petrof BJ, Hamid Q, Fraser R, Kimoff RJ (2004) Upper airway muscle inflammation and denervation changes in obstructive sleep apnea. Am J Respir Crit Care Med 170(5):541–546

    Article  Google Scholar 

  13. Friberg D, Ansved T, Borg K, Carlsson-Nordlander B, Larsson H, Svanborg E (1998) Histological indications of a progressive snorers disease in an upper airway muscle. Am J Respir Crit Care Med 157(2):586–593

    Google Scholar 

  14. Friberg D, Gazelius B, Lindblad LE, Nordlander B (1998) Habitual snorers and sleep apnoics have abnormal vascular reactions of the soft palatal mucosa on afferent nerve stimulation. Laryngoscope 108(3):431–436

    Article  Google Scholar 

  15. Guilleminault C, Huang YS, Kirisoglu C, Chan A (2005) Is obstructive sleep apnea syndrome a neurological disorder? A continuous positive airway pressure follow-up study. Ann Neurol 58(6):880–887

    Article  Google Scholar 

  16. Kimoff RJ, Sforza E, Champagne V, Ofiara L, Gendron D (2001) Upper airway sensation in snoring and obstructive sleep apnea. Am J Respir Crit Care Med 164(2):250–255

    Google Scholar 

  17. Khoo MC, Kronauer RE, Strohl KP, Slutsky AS (1982) Factors inducing periodic breathing in humans: a general model. J Appl Physiol 53(3):644–659

    Google Scholar 

  18. Younes M (1992) Proportional assist ventilation, a new approach to ventilatory support. Theory. Am Rev Respir Dis 145(1):114–120

    Article  Google Scholar 

  19. Wellman A, Jordan AS, Malhotra A, Fogel RB, Katz ES, Schory K, White DP (2004) Ventilatory control and airway anatomy in obstructive sleep apnea. Am J Respir Crit Care Med 170(11):1225–1232

    Article  Google Scholar 

  20. Younes M, Ostrowski M, Thompson W, Leslie C, Shewchuk W (2001) Chemical control stability in patients with obstructive sleep apnea. Am J Respir Crit Care Med 163(5):1181–1190

    Google Scholar 

  21. Series F, Marc I (1994) Influence of lung volume dependence of upper airway resistance during continuous negative airway pressure. J Appl Physiol 77(2):840–844

    Google Scholar 

  22. Series F, Cormier Y, Desmeules M (1990) Influence of passive changes of lung volume on upper airways. J Appl Physiol 68(5):2159–2164

    Google Scholar 

  23. Hudgel DW, Devadatta P (1984) Decrease in functional residual capacity during sleep in normal humans. J Appl Physiol 57(5):1319–1322

    Google Scholar 

  24. Kay A, Trinder J, Kim Y (1996) Progressive changes in airway resistance during sleep. J Appl Physiol 81(1):282–292

    Google Scholar 

  25. Van de Graaff WB (1988) Thoracic influence on upper airway patency. J Appl Physiol 65(5):2124–2131

    Google Scholar 

  26. Van de Graaff WB (1991) Thoracic traction on the trachea: mechanisms and magnitude. J Appl Physiol 70(3):1328–1336

    Google Scholar 

  27. Isono S, Remmers JE, Tanaka A, Sho Y, Sato J, Nishino T (1997) Anatomy of pharynx in patients with obstructive sleep apnea and in normal subjects. J Appl Physiol 82(4):1319–1326

    Google Scholar 

  28. Strohl KP, Redline S (1986) Nasal CPAP therapy, upper airway muscle activation, and obstructive sleep apnea. Am Rev Respir Dis 134(3):555–558

    Google Scholar 

  29. Sullivan CE, Issa FG, Berthon-Jones M, Eves L (1981) Reversal of obstructive sleep apnoea by continuous positive airway pressure applied through the nares. Lancet 1(8225):862–865

    Article  Google Scholar 

  30. Kuna ST, Bedi DG, Ryckman C (1988) Effect of nasal airway positive pressure on upper airway size and configuration. Am Rev Respir Dis 138(4):969–975

    Article  Google Scholar 

  31. Schwab RJ, Pack AI, Gupta KB, Metzger LJ, Oh E, Getsy JE, Gefter WB (1996) Upper airway and soft tissue structural changes induced by CPAP in normal subjects. Am J Respir Crit Care Med 154(4 Pt 1):1106–1116

    Google Scholar 

  32. Rodenstein DO, Dooms G, Thomas Y, Liistro G, Stanescu DC, Culee C, Aubert-Tulkens G (1990) Pharyngeal shape and dimensions in healthy subjects, snorers, and patients with obstructive sleep apnoea. Thorax 45(10):722–727

    Article  Google Scholar 

  33. Ballester E, Badia JR, Hernandez L, Carrasco E, de Pablo J, Fornas C, Montserrat JM (1999) Evidence of the effectiveness of continuous positive airway pressure in the treatment of sleep apnea/hypopnea syndrome. Am J Respir Crit Care Med 159(2):495–501

    Google Scholar 

  34. Jenkinson C, Davies RJ, Mullins R, Stradling JR (1999) Comparison of therapeutic and subtherapeutic nasal continuous positive airway pressure for obstructive sleep apnoea: a randomised prospective parallel trial. Lancet 353(9170):2100–2105

    Article  Google Scholar 

  35. Montserrat JM, Ferrer M, Hernandez L, Farre R, Vilagut G, Navajas D, Ballester E (2001) Effectiveness of CPAP treatment in daytime function in sleep apnea syndrome: a randomized controlled study with an optimized placebo. Am J Respir Crit Care Med 164(4):608–613

    Google Scholar 

  36. Beninati W, Harris CD, Herold DL, Shepard JW Jr (1999) The effect of snoring and obstructive sleep apnea on the sleep quality of bed partners. Mayo Clin Proc 74(10):955–958

    Google Scholar 

  37. Parish JM, Lyng PJ (2003) Quality of life in bed partners of patients with obstructive sleep apnea or hypopnea after treatment with continuous positive airway pressure. Chest 124(3):942–947

    Article  Google Scholar 

  38. Ali NJ, Davies RJ, Fleetham JA, Stradling JR (1992) The acute effects of continuous positive airway pressure and oxygen administration on blood pressure during obstructive sleep apnea. Chest 101(6):1526–1532

    Article  Google Scholar 

  39. Dimsdale JE, Loredo JS, Profant J (2000) Effect of continuous positive airway pressure on blood pressure: a placebo trial. Hypertension 35(1 Pt 1):144–147

    Article  Google Scholar 

  40. Somers VK, Dyken ME, Clary MP, Abboud FM (1995) Sympathetic neural mechanisms in obstructive sleep apnea. J Clin Invest 96(4):1897–1904

    Article  Google Scholar 

  41. Haentjens P, Van Meerhaeghe A, Moscariello A, De Weerdt S, Poppe K, Dupont A, Velkeniers B (2007) The impact of continuous positive airway pressure on blood pressure in patients with obstructive sleep apnea syndrome: evidence from a meta-analysis of placebo-controlled randomized trials. Arch Intern Med 167(8):757–764

    Article  Google Scholar 

  42. Duran-Cantolla J, Aizpuru F, Montserrat JM, Ballester E, Teran-Santos J, Aguirregomoscorta JI, Barbe F (2010) Continuous positive airway pressure as treatment for systemic hypertension in people with obstructive sleep apnoea: randomised controlled trial. BMJ 341:c5991. doi: 10.1136/bmj.c5991[pii]

    Article  Google Scholar 

  43. Bazzano LA, Khan Z, Reynolds K, He J (2007) Effect of nocturnal nasal continuous positive airway pressure on blood pressure in obstructive sleep apnea. Hypertension 50(2):417–423. doi:HYPERTENSIONAHA.106.085175 [pii] 10.1161/HYPERTENSIONAHA.106.085175

    Article  Google Scholar 

  44. Kaneko Y, Floras JS, Usui K, Plante J, Tkacova R, Kubo T, Bradley TD (2003) Cardiovascular effects of continuous positive airway pressure in patients with heart failure and obstructive sleep apnea. N Engl J Med 348(13):1233–1241

    Article  Google Scholar 

  45. Mansfield DR, Gollogly NC, Kaye DM, Richardson M, Bergin P, Naughton MT (2004) Controlled trial of continuous positive airway pressure in obstructive sleep apnea and heart failure. Am J Respir Crit Care Med 169(3):361–366

    Article  Google Scholar 

  46. Chaouat A, Weitzenblum E, Kessler R, Oswald M, Sforza E, Liegeon MN, Krieger J (1997) Five-year effects of nasal continuous positive airway pressure in obstructive sleep apnoea syndrome. Eur Respir J 10(11):2578–2582

    Article  Google Scholar 

  47. Sajkov D, Wang T, Saunders NA, Bune AJ, McEvoy RD (2002) Continuous positive airway pressure treatment improves pulmonary hemodynamics in patients with obstructive sleep apnea. Am J Respir Crit Care Med 165(2):152–158

    Google Scholar 

  48. Kanagala R, Murali NS, Friedman PA, Ammash NM, Gersh BJ, Ballman KV, Somers VK (2003) Obstructive sleep apnea and the recurrence of atrial fibrillation. Circulation 107(20):2589–2594

    Google Scholar 

  49. Ryan CM, Usui K, Floras JS, Bradley TD (2005) Effect of continuous positive airway pressure on ventricular ectopy in heart failure patients with obstructive sleep apnoea. Thorax 60(9):781–785

    Article  Google Scholar 

  50. Harbison J, O’Reilly P, McNicholas WT (2000) Cardiac rhythm disturbances in the obstructive sleep apnea syndrome: effects of nasal continuous positive airway pressure therapy. Chest 118(3):591–595

    Article  Google Scholar 

  51. Simantirakis EN, Schiza SI, Marketou ME, Chrysostomakis SI, Chlouverakis GI, Klapsinos NC, Vardas PE (2004) Severe bradyarrhythmias in patients with sleep apnoea: the effect of continuous positive airway pressure treatment: a long-term evaluation using an insertable loop recorder. Eur Heart J 25(12):1070–1076

    Article  Google Scholar 

  52. George CF (2001) Reduction in motor vehicle collisions following treatment of sleep apnoea with nasal CPAP. Thorax 56(7):508–512

    Article  Google Scholar 

  53. Findley L, Smith C, Hooper J, Dineen M, Suratt PM (2000) Treatment with nasal CPAP decreases automobile accidents in patients with sleep apnea. Am J Respir Crit Care Med 161(3 Pt 1):857–859

    Google Scholar 

  54. Kushida CA, Littner MR, Hirshkowitz M, Morgenthaler TI, Alessi CA, Bailey D, Wise MS (2006) Practice parameters for the use of continuous and bilevel positive airway pressure devices to treat adult patients with sleep-related breathing disorders. Sleep 29(3):375–380

    Google Scholar 

  55. Dohi T, Kasai T, Narui K, Ishiwata S, Ohno M, Yamaguchi T, Momomura S (2008) Bi-level positive airway pressure ventilation for treating heart failure with central sleep apnea that is unresponsive to continuous positive airway pressure. Circ J 72(7):1100–1105

    Article  Google Scholar 

  56. Hu K, Li QQ, Yang J, Chen XQ, Hu SP, Wu XJ (2006) The role of high-frequency jet ventilation in the treatment of Cheyne-Stokes respiration in patients with chronic heart failure. Int J Cardiol 106(2):224–231

    Article  Google Scholar 

  57. Philippe C, Stoica-Herman M, Drouot X, Raffestin B, Escourrou P, Hittinger L, D’Ortho MP (2006) Compliance with and effectiveness of adaptive servoventilation versus continuous positive airway pressure in the treatment of Cheyne-Stokes respiration in heart failure over a six month period. Heart 92(3):337–342

    Article  Google Scholar 

  58. Ruttanaumpawan P, Logan AG, Floras JS, Bradley TD (2009) Effect of continuous positive airway pressure on sleep structure in heart failure patients with central sleep apnea. Sleep 32(1):91–98

    Google Scholar 

  59. Javaheri S, Malik A, Smith J, Chung E (2008) Adaptive pressure support servoventilation: a novel treatment for sleep apnea associated with use of opioids. J Clin Sleep Med 4(4):305–310

    Google Scholar 

  60. Resta O, Guido P, Picca V, Sabato R, Rizzi M, Scarpelli F, Sergi M (1998) Prescription of nCPAP and nBIPAP in obstructive sleep apnoea syndrome: Italian experience in 105 subjects. A prospective two centre study. Respir Med 92(6):820–827

    Article  Google Scholar 

  61. Schafer H, Ewig S, Hasper E, Luderitz B (1998) Failure of CPAP therapy in obstructive sleep apnoea syndrome: predictive factors and treatment with bilevel-positive airway pressure. Respir Med 92(2):208–215

    Article  Google Scholar 

  62. Kushida CA, Chediak A, Berry RB, Brown LK, Gozal D, Iber C, Rowley JA (2008) Clinical guidelines for the manual titration of positive airway pressure in patients with obstructive sleep apnea. J Clin Sleep Med 4(2):157–171

    Google Scholar 

  63. Aloia MS, Stanchina M, Arnedt JT, Malhotra A, Millman RP (2005) Treatment adherence and outcomes in flexible vs standard continuous positive airway pressure therapy. Chest 127(6):2085–2093

    Article  Google Scholar 

  64. Mulgrew AT, Cheema R, Fleetham J, Ryan CF, Ayas NT (2007) Efficacy and patient satisfaction with autoadjusting CPAP with variable expiratory pressure vs standard CPAP: a two-night randomized crossover trial. Sleep Breath 11(1):31–37

    Article  Google Scholar 

  65. Ruhle KH, Domanski U, Happel A, Nilius G (2007) Analysis of expiratory pressure reduction (C-Flex method) during CPAP therapy. Pneumologie 61(2):86–89

    Article  Google Scholar 

  66. Gay PC (2008) Complex sleep apnea: it really is a disease. J Clin Sleep Med 4(5):403–405

    MathSciNet  Google Scholar 

  67. Malhotra A, Bertisch S, Wellman A (2008) Complex sleep apnea: it isn’t really a disease. J Clin Sleep Med 4(5):406–408

    Google Scholar 

  68. Dernaika T, Tawk M, Nazir S, Younis W, Kinasewitz GT (2007) The significance and outcome of continuous positive airway pressure-related central sleep apnea during split-night sleep studies. Chest 132(1):81–87

    Article  Google Scholar 

  69. Nino-Murcia G, McCann CC, Bliwise DL, Guilleminault C, Dement WC (1989) Compliance and side effects in sleep apnea patients treated with nasal continuous positive airway pressure. West J Med 150(2):165–169

    Google Scholar 

  70. Pepin JL, Krieger J, Rodenstein D, Cornette A, Sforza E, Delguste P, Levy P (1999) Effective compliance during the first 3 months of continuous positive airway pressure A European prospective study of 121 patients. Am J Respir Crit Care Med 160(4):1124–1129

    Google Scholar 

  71. Engleman HM, Wild MR (2003) Improving CPAP use by patients with the sleep apnoea/hypopnoea syndrome (SAHS). Sleep Med Rev 7(1):81–99

    Article  Google Scholar 

  72. Rauscher H, Popp W, Wanke T, Zwick H (1991) Acceptance of CPAP therapy for sleep apnea. Chest 100(4):1019–1023

    Article  Google Scholar 

  73. Kribbs NB, Pack AI, Kline LR, Smith PL, Schwartz AR, Schubert NM, Dinges DF (1993) Objective measurement of patterns of nasal CPAP use by patients with obstructive sleep apnea. Am Rev Respir Dis 147(4):887–895

    Google Scholar 

  74. Engleman HM, Asgari-Jirhandeh N, McLeod AL, Ramsay CF, Deary IJ, Douglas NJ (1996) Self-reported use of CPAP and benefits of CPAP therapy: a patient survey. Chest 109(6):1470–1476

    Article  Google Scholar 

  75. Stradling JR, Davies RJ (2000) Is more NCPAP better? Sleep 23(Suppl 4):S150–S153

    Google Scholar 

  76. Popescu G, Latham M, Allgar V, Elliott MW (2001) Continuous positive airway pressure for sleep apnoea/hypopnoea syndrome: usefulness of a 2 week trial to identify factors associated with long term use. Thorax 56(9):727–733

    Article  Google Scholar 

  77. Hoy CJ, Vennelle M, Kingshott RN, Engleman HM, Douglas NJ (1999) Can intensive support improve continuous positive airway pressure use in patients with the sleep apnea/hypopnea syndrome? Am J Respir Crit Care Med 159(4 Pt 1):1096–1100

    Google Scholar 

  78. Kalan A, Kenyon GS, Seemungal TA, Wedzicha JA (1999) Adverse effects of nasal continuous positive airway pressure therapy in sleep apnoea syndrome. J Laryngol Otol 113(10):888–892

    Article  Google Scholar 

  79. Brander PE, Soirinsuo M, Lohela P (1999) Nasopharyngeal symptoms in patients with obstructive sleep apnea syndrome. Effect of nasal CPAP treatment. Respiration 66(2):128–135

    Article  Google Scholar 

  80. Abisheganaden J, Chan CC, Chee CB, Yap JC, Poh SC, Wang YT, Cheong TH (1998) The obstructive sleep apnoea syndrome – experience of a referral centre. Singapore Med J 39(8):341–346

    Google Scholar 

  81. Massie CA, Hart RW, Peralez K, Richards GN (1999) Effects of humidification on nasal symptoms and compliance in sleep apnea patients using continuous positive airway pressure. Chest 116(2):403–408

    Article  Google Scholar 

  82. Neill AM, Wai HS, Bannan SP, Beasley CR, Weatherall M, Campbell AJ (2003) Humidified nasal continuous positive airway pressure in obstructive sleep apnoea. Eur Respir J 22(2):258–262

    Article  Google Scholar 

  83. Hoffstein V, Viner S, Mateika S, Conway J (1992) Treatment of obstructive sleep apnea with nasal continuous positive airway pressure. Patient compliance, perception of benefits, and side effects. Am Rev Respir Dis 145(4 Pt 1):841–845

    Google Scholar 

  84. Lojander J, Brander PE, Ammala K (1999) Nasopharyngeal symptoms and nasal continuous positive airway pressure therapy in obstructive sleep apnoea syndrome. Acta Otolaryngol 119(4):497–502

    Article  Google Scholar 

  85. Massie CA, Hart RW (2003) Clinical outcomes related to interface type in patients with obstructive sleep apnea/hypopnea syndrome who are using continuous positive airway pressure. Chest 123(4):1112–1118

    Article  Google Scholar 

  86. Prosise GL, Berry RB (1994) Oral-nasal continuous positive airway pressure as a treatment for obstructive sleep apnea. Chest 106(1):180–186

    Article  Google Scholar 

  87. Teschler H, Berthon-Jones M, Thompson AB, Henkel A, Henry J, Konietzko N (1996) Automated continuous positive airway pressure titration for obstructive sleep apnea syndrome. Am J Respir Crit Care Med 154(3 Pt 1):734–740

    Google Scholar 

  88. Abdenbi F, Chambille B, Escourrou P (2004) Bench testing of auto-adjusting positive airway pressure devices. Eur Respir J 24(4):649–658

    Article  Google Scholar 

  89. Farre R, Montserrat JM, Rigau J, Trepat X, Pinto P, Navajas D (2002) Response of automatic continuous positive airway pressure devices to different sleep breathing patterns: a bench study. Am J Respir Crit Care Med 166(4):469–473

    Article  Google Scholar 

  90. Lofaso F, Desmarais G, Leroux K, Zalc V, Fodil R, Isabey D, Louis B (2006) Bench evaluation of flow limitation detection by automated continuous positive airway pressure devices. Chest 130(2):343–349

    Article  Google Scholar 

  91. Haniffa M, Lasserson TJ, Smith I (2004) Interventions to improve compliance with continuous positive airway pressure for obstructive sleep apnoea. Cochrane Database Syst Rev 4:CD003531

    Google Scholar 

  92. Noseda A, Kempenaers C, Kerkhofs M, Braun S, Linkowski P, Jann E (2004) Constant vs auto-continuous positive airway pressure in patients with sleep apnea hypopnea syndrome and a high variability in pressure requirement. Chest 126(1):31–37. doi:10.1378/chest.126.1.31 [pii]

    Article  Google Scholar 

  93. Berry RB, Parish JM, Hartse KM (2002) The use of auto-titrating continuous positive airway pressure for treatment of adult obstructive sleep apnea. An American Academy of Sleep Medicine review. Sleep 25(2):148–173

    Google Scholar 

  94. Randerath W, Parys K, Lehmann D, Sanner B, Feldmeyer F, Ruhle KH (2000) Self-adjusting continuous positive airway pressure therapy based on the measurement of impedance. A comparison of free pressure variation and individually fixed higher minimum pressure. Respiration 67(3):272–279. doi:29510 [pii]

    Article  Google Scholar 

  95. Randerath WJ, Galetke W, David M, Siebrecht H, Sanner B, Ruhle K (2001) Prospective randomized comparison of impedance-controlled auto-continuous positive airway pressure (APAP(FOT)) with constant CPAP. Sleep Med 2(2):115–124. doi:S138994570084 [pii]

    Article  Google Scholar 

  96. Planes C, D’Ortho MP, Foucher A, Berkani M, Leroux K, Essalhi M, Lofaso F (2003) Efficacy and cost of home-initiated auto-nCPAP versus conventional nCPAP. Sleep 26(2):156–160

    Google Scholar 

  97. Senn O, Brack T, Matthews F, Russi EW, Bloch KE (2003) Randomized short-term trial of two autoCPAP devices versus fixed continuous positive airway pressure for the treatment of sleep apnea. Am J Respir Crit Care Med 168(12):1506–1511. doi:10.1164/rccm.200304-542OC [pii]

    Article  Google Scholar 

  98. Teschler H, Wessendorf TE, Farhat AA, Konietzko N, Berthon-Jones M (2000) Two months auto-adjusting versus conventional nCPAP for obstructive sleep apnoea syndrome. Eur Respir J 15(6):990–995

    Article  Google Scholar 

  99. Hirose M, Honda J, Sato E, Shinbo T, Kokubo K, Ichiwata T, Kobayashi H (2008) Bench study of auto-CPAP devices using a collapsible upper airway model with upstream resistance. Respir Physiol Neurobiol 162(1):48–54. doi:S1569-9048(08)00081-5 [pii] 10.1016/j.resp. 2008.03.014

    Article  Google Scholar 

  100. Rigau J, Montserrat JM, Wohrle H, Plattner D, Schwaibold M, Navajas D, Farre R (2006) Bench model to simulate upper airway obstruction for analyzing automatic continuous positive airway pressure devices. Chest 130(2):350–361. doi:130/2/350 [pii] 10.1378/chest.130.2.350

    Article  Google Scholar 

  101. Bachour A, Virkkala JT, Maasilta PK (2007) AutoCPAP initiation at home: optimal trial duration and cost-effectiveness. Sleep Med 8(7–8):704–710. doi:S1389-9457(07)6-9 [pii] 10.1016/j.sleep. 2007.01.010

    Article  Google Scholar 

  102. Roldan N, Sampol G, Sagales T, Romero O, Jurado MJ, Rios J, Lloberes P (2008) Cost-effectiveness analysis of automatic titration of continuous positive airway pressure at home in 1 night versus 2 nights. Arch Bronconeumol 44(12):664–670. doi:13130404 [pii]

    Article  Google Scholar 

  103. Waldhorn RE, Herrick TW, Nguyen MC, O’Donnell AE, Sodero J, Potolicchio SJ (1990) Long-term compliance with nasal continuous positive airway pressure therapy of obstructive sleep apnea. Chest 97(1):33–38

    Article  Google Scholar 

  104. Resta O, Guido P, Picca V, Scarpelli F, Foschino MP (1999) The role of the expiratory phase in obstructive sleep apnoea. Respir Med 93(3):190–195

    Article  Google Scholar 

  105. Badia JR, Farre R, Montserrat JM, Ballester E, Hernandez L, Rotger M, Navajas D (1998) Forced oscillation technique for the evaluation of severe sleep apnoea/hypopnoea syndrome: a pilot study. Eur Respir J 11(5):1128–1134

    Article  Google Scholar 

  106. Nilius G, Happel A, Domanski U, Ruhle KH (2006) Pressure-relief continuous positive airway pressure vs constant continuous positive airway pressure: a comparison of efficacy and compliance. Chest 130(4):1018–1024

    Article  Google Scholar 

  107. Morgenthaler TI (2008) Rapidly proliferating PAP and the broadening gap. Sleep Med 9(8):813–815

    Article  Google Scholar 

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  1. Division of Pulmonary and Critical Care Medicine, Center for Sleep Medicine, Mayo Clinic, Rochester, MN, USA

    Kannan Ramar M.D.

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  1. , School of Medicine, Fu Jen Catholic University, Wen Chang Road, Shih Lin District 95, Taipei, -, Taiwan R.O.C.

    Rayleigh Ping-Ying Chiang

  2. , Department of Civil Engineering, National Taiwan University, No. 1, Sec. 4, Roosevelt Road, Taipei, 10617, Taiwan R.O.C.

    Shih-Chun (Jessy) Kang

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Ramar, K. (2012). Management of Sleep Disorders: CPAP (Continuous Positive Airway Pressure). In: Chiang, RY., Kang, SC. (eds) Introduction to Modern Sleep Technology. Intelligent Systems, Control and Automation: Science and Engineering, vol 64. Springer, Dordrecht. https://doi.org/10.1007/978-94-007-5470-6_4

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  • DOI: https://doi.org/10.1007/978-94-007-5470-6_4

  • Published:

  • Publisher Name: Springer, Dordrecht

  • Print ISBN: 978-94-007-5469-0

  • Online ISBN: 978-94-007-5470-6

  • eBook Packages: Computer ScienceComputer Science (R0)

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