continuous positive airway pressure (CPAP) <non-invasive>
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Physiology
- increases lung volumes at end-expiration
- tidal volume is determined by patient effort without ventilatory assistance or with pressure support from a ventilator
- the expiratory support of CPAP improves gas exchange by preventing alveolar collapse
Indications
- maintenance of humidified respiratory pressure above ambient pressure
- treatment of choice for most patients with obstructive sleep apnea (OSA)*
- hypoxia due to postoperative atelectasis (obesity)[5][11]
- excessive daytime sleepiness
- may improve depression in patients with cardiovascular disease[17]
* The level of CPAP should be optimized in a controlled monitored setting.
Contraindications
- mechanical issues: unable to fit mask, large air leak
- recent facial trauma or surgery
- facial deformity
- edentulous patients[7]
- sinus or nasal congestion
- septal deviation
- does not provide ventilatory support[5]
- does not reduce cardiovascular risk in patients with cardiovascular disease & obstructive sleep apnea[15]
Advantages
- symptomatic improvement in patients with sleep apnea
- may improve glycemic control in patients with sleep apnea & diabetes mellitus type 2*[3]
- improves LVEF in patients with OSA & CHF
- elimination of apneas
- elimination of snoring
- normalization of oxygen saturation
- improvement in sleep quality[5]
- may lower blood pressure in hypertensive patients with obstructive sleep apnea[6][12]
- improves daytime sleepiness[5]
* decrease in HgbA1c of < 0.5%[3]
Benefit/risk
Adverse effects
- nasal complaints
- eye complaints
- discomfort
- intolerance to noise of device itself
Management
- eszopiclone (Lunesta) 3 mg QHS with the first 2 weeks of CPAP improves compliance long after discontinuation[5]
- heat humidification may relieve nasal congestion[5][10]
- use of motivational interviewing techniques improves compliance[13]
Notes
- CPAP per se does not provide any ventilatory support, but can be added to mechanical ventilation or used in combination with non-invasive ventilatory support
More general terms
Additional terms
- auto-adjusting positive airway pressure (APAP) <non-invasive>
- mechanical ventilation (assisted ventilation)
References
- ↑ Manual of Medical Therapeutics, 28th ed, Ewald & McKenzie (eds), Little, Brown & Co, Boston, 1995, pg 257
- ↑ Journal Watch 24(14):115, 2004 Esteban A, Frutos-Vivar F, Ferguson ND, Arabi Y, Apezteguia C, Gonzalez M, Epstein SK, Hill NS, Nava S, Soares MA, D'Empaire G, Alia I, Anzueto A. Noninvasive positive-pressure ventilation for respiratory failure after extubation. N Engl J Med. 2004 Jun 10;350(24):2452-60. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15190137
- ↑ 3.0 3.1 3.2 Journal Watch 25(7):54, 2005 Babu AR, Herdegen J, Fogelfeld L, Shott S, Mazzone T. Type 2 diabetes, glycemic control, and continuous positive airway pressure in obstructive sleep apnea. Arch Intern Med. 2005 Feb 28;165(4):447-52. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15738376
- ↑ Lettieri CJ et al Effects of a short course of eszopiclone on continuous positive airway pressure adherence: A randomized trial. Ann Intern Med 2009 Nov 17; 151:696. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19920270
- ↑ 5.0 5.1 5.2 5.3 5.4 5.5 5.6 Medical Knowledge Self Assessment Program (MKSAP) 15, 16, 18. American College of Physicians, Philadelphia 2009, 2012, 2018,
- ↑ 6.0 6.1 Duran-Cantolla J et al. Continuous positive airway pressure as treatment for systemic hypertension in people with obstructive sleep apnoea: Randomised controlled trial. BMJ 2010 Nov 24; 341:c5991 PMID: https://www.ncbi.nlm.nih.gov/pubmed/21106625
- ↑ 7.0 7.1 Russell T, Duntley S. Sleep-disordered breathing in the elderly. Am J Med 2011; 124:1123-1126 PMID: https://www.ncbi.nlm.nih.gov/pubmed/21906711
- ↑ Jon D. Hirasuna, M.D. Clinical Professor of Medicine, UC Davis, Associate Clinical Professor of Medicine, UCSF, Sept 1997
- ↑ Weng CL, Zhao YT, Liu QH, Fu CJ, Sun F, Ma YL, Chen YW, He QY. Meta-analysis: Noninvasive ventilation in acute cardiogenic pulmonary edema. Ann Intern Med. 2010 May 4;152(9):590-600 PMID: https://www.ncbi.nlm.nih.gov/pubmed/20439577
- ↑ 10.0 10.1 Neill AM, Wai HS, Bannan SP et al Humidified nasal continuous positive airway pressure in obstructive sleep apnoea. Eur Respir J. 2003 Aug;22(2):258-62. PMID: https://www.ncbi.nlm.nih.gov/pubmed/12952257
- ↑ 11.0 11.1 Squadrone V, Coha M, Cerutti E et al Continuous positive airway pressure for treatment of postoperative hypoxemia: a randomized controlled trial. JAMA. 2005 Feb 2;293(5):589-95. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15687314
- ↑ 12.0 12.1 Martinez-Garcia MA et al Effect of CPAP on Blood Pressure in Patients With Obstructive Sleep Apnea and Resistant Hypertension. The HIPARCO Randomized Clinical Trial. JAMA. 2013;310(22):2407-2415 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24327037 <Internet> http://jama.jamanetwork.com/article.aspx?articleid=1788459
- ↑ 13.0 13.1 Lai AYK et al. The efficacy of a brief motivational enhancement education program on CPAP adherence in OSA: A randomized controlled trial. Chest 2014 Sep; 146:600 PMID: https://www.ncbi.nlm.nih.gov/pubmed/24810282
- ↑ Keenan SP, Sinuff T, Burns KE et al Clinical practice guidelines for the use of noninvasive positive-pressure ventilation and noninvasive continuous positive airway pressure in the acute care setting. CMAJ. 2011 Feb 22;183(3):E195-214. PMID: https://www.ncbi.nlm.nih.gov/pubmed/21324867 Free PMC Article
- ↑ 15.0 15.1 McEvoy RD et al. CPAP for prevention of cardiovascular events in obstructive sleep apnea. N Engl J Med 2016 Aug 28; <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/27571048 <Internet> http://www.nejm.org/doi/10.1056/NEJMoa1606599
- ↑ Sommer JU, Kraus M, Birk R et al Functional short- and long-term effects of nasal CPAP with and without humidification on the ciliary function of the nasal respiratory epithelium. Sleep Breath. 2014 Mar;18(1):85-93. PMID: https://www.ncbi.nlm.nih.gov/pubmed/23657665
- ↑ 17.0 17.1 Zheng D, Xu Y, You S et al. Effects of continuous positive airway pressure on depression and anxiety symptoms in patients with obstructive sleep apnoea: Results from the Sleep Apnoea Cardiovascular Endpoint randomised trial and meta-analysis. EClinicalMedicine 2019 May/Jun; 11:89 PMID: https://www.ncbi.nlm.nih.gov/pubmed/31312807 Free PMC Article https://www.sciencedirect.com/science/article/pii/S2589537019300902
- ↑ FDA Safety Communication. Feb 27, 2020 Potential Risks Associated With The Use of Ozone and Ultraviolet (UV) Light Products for Cleaning CPAP Machines and Accessories. https://www.fda.gov/medical-devices/safety-communications/potential-risks-associated-use-ozone-and-ultraviolet-uv-light-products-cleaning-cpap-machines-and
Patient information
continuous positive airway pressure (CPAP) patient information