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KMID : 1002120080050020064
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Journal of Korean Sleep Research Society
2008 Volume.5 No. 2 p.64 ~ p.69
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Positive Pressure Therapy; When CPAP fails, what other PAP modalities are?
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Joo Eun-Yeon
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Abstract
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Positive airway pressure (PAP) is the treatment of choice for patients with moderate-to-severe obstructive sleep apnea (OSA). PAP can effectively reduce the apnea-hypopnea index and improve subjective and objective sleepiness. Also it can gives benefits in sleep quality and quality of life for both the patient and bed partner. Since continuous PAP (CPAP) treatment of OSA was described, additional modes of pressure delivery have been developed (bilevel PAP, autoadjusting PAP, flexible PAP). While none of the variants of PAP improves adherence in unselected patients compared to CPAP, individual patients may respond to a change in pressure mode. Although attended PAP titration remains the standard of practice for selecting a treatment pressure, use of autotitrating PAP devices in the unattended setting can provide an effective titration alternative with careful patient selection and review of titration results. However, despite the increase in PAP treatment options, lack of acceptance and inadequate adherence to PAP therapy remain the major causes of treatment failure. Heated humidification can improve PAP adherence, especially in patients with nasal congestion or dryness.
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KEYWORD
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Positive airway pressure (PAP), Obstructive sleep apnea (OSA), Continuous PAP (CPAP), Bilevel PAP, Autoadjusting PAP, Flexible PAP
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