ABSTRACT
Sleep apnoea syndromes 292
Obstructive sleep apnoea, hypertension, ischaemic heart disease and stroke 294
Sleep disordered breathing and heart failure 295
Obstructive sleep apnoea and the metabolic syndrome 295
Obstructive sleep apnoea, cognitive effects and driving 295
Assessment and investigation 296
Pathophysiology and mechanism of action of CPAP in OSA 299
Indications for continuous positive airway pressure 300
Body position modification 301
Weight reduction 302
Oral devices 302
Devices to promote nasal patency 304
Upper airway surgery 304
Cardiac pacing/resynchronization 307
Pharmacological treatment 307
Other interventions 307
Effects of CPAP in obstructive sleep apnoea 308
CPAP therapy in central sleep apnoea 308
Choice of CPAP equipment for domiciliary use 308
Mask selection 309
Starting continuous positive airway pressure 309
CPAP or bilevel pressure support ventilation? 311
Compliance 311
Practical problems 312
Common questions about CPAP from patients 315
References 316
Continuous positive airway pressure (CPAP) therapy was introduced as a treatment for obstructive sleep apnoea (OSA) by Sullivan and colleagues1 in 1981. It has revolutionized the approach to this condition, virtually abolishing the need for tracheostomy which was previously recommended for severe OSA. There is now a large evidence base, including meta-analyses,2,3 supporting the use of CPAP in moderate and severe OSA, where it has been shown to reverse daytime sleepiness. However, controversy remains regarding the effectiveness of CPAP in mild OSA,4,5 and the extent of the association between OSA and cardiovascular/cerebrovascular disease. There is increasing interest in the impact of CPAP on insulin resistance, the metabolic syndrome6 and the cognitive impairment often seen in OSA patients. CPAP also has a role in patients with acute hypoxaemia due to conditions such as pneumonia and pulmonary oedema (described in Chapter 5); and has a debatable role in central sleep apnoea. As the major application is in OSA, this use will be covered in detail. Alternative approaches including weight loss strategies, the mandibular advancement splint/oral devices, upper airway surgery and pharmacological measures will be compared and contrasted with CPAP.
