continuous positive airway pressure in sleep apnoea syndrome

many patients with documented sleep apnea require more than conservative therapy
continuous positive airway pressure (CPAP) is the most consistently successful and extensively studied treatment for obstructive sleep apnea
continuous positive airway pressure (CPAP) may also be used as a treatment measure in patients with sleep apnoea syndrome.
CPAP is achieved with the use of a special nasal mask that increases the pressure in the pharynx by about 1kPa and so keeps the walls of the pharynx apart
there is evidence that CPAP improves subjective and objective measures of sleepiness more than placebo (1) - this study shows that CPAP is effective in for improving sleepiness in a wide range of patients with obstructive sleep apnoea. CPAP provides more benefit is patients with more severe problems and is more likely to be used with these patients
CPAP treatment prevents the throat from closing and so reduces apnoeas and hypopnoeas
- CPAP also reduces daytime sleepiness and improves daytime vigilance and cognitive functioning - it is likely to be needed life-long (2)
patients using CPAP therapy commonly experience minor unwanted effects, including rhinitis, sores on the nasal bridge, discomfort and claustrophobia (2) - rarer, and more troublesome, adverse effects include nosebleeds and sinusitis

NICE state that (3):

continuous positive airway pressure (CPAP) is recommended as a treatment option for adults with moderate or severe symptomatic obstructive sleep apnoea/hypopnoea syndrome (OSAHS)
- moderate to severe OSAHS can be diagnosed from patient history and a sleep study using oximetry or other monitoring devices carried out in the person's home. In some cases, further studies that monitor additional physiological variables in a sleep laboratory or at home may be required, especially when alternative diagnoses are being considered
  - severity of OSAHS is usually assessed on the basis of both severity of symptoms (particularly the degree of sleepiness) and the sleep study, by using either the apnoea/hypopnoea index (AHI) or the oxygen desaturation index
    - OSAHS is considered mild when the AHI is 5-14 in a sleep study, moderate when the AHI is 15-30, and severe when the AHI is over 30
CPAP is only recommended as a treatment option for adults with mild OSAHS if:
- they have symptoms that affect their quality of life and ability to go about their daily activities, and
- lifestyle advice and any other relevant treatment options have been unsuccessful or are considered inappropriate
the diagnosis and treatment of OSAHS, and the monitoring of the response, should be carried out by a specialist service with appropriately trained medical and support staff.

Notes:

CPAP machines contain a fan that blows air under pressure into the nostrils
the airflow acts as a pneumatic splint that keeps the pharyngeal airway open
CPAP is recommended for patients with symptomatic obstructive sleep apnea even if the apnea–hypopnea index is in the mild range (5 to 15) (4)
CPAP is not curative, and patients must use the mask whenever they sleep (5)

Reference:

Last reviewed 01/2018

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