==================================HSR40================================== 40. Continuous positive airway pressure (CAPD) for obstructive sleep apnea. 1 UI - 87016105 AU - Guilleminault C ; Nino-Murcia G ; Heldt G ; Baldwin R ; Hutchinson D TI - Alternative treatment to tracheostomy in obstructive sleep apnea syndrome: nasal continuous positive airway pressure in young children. AB - Two groups of prepubertal children with severe obstructive sleep apnea syndrome received continuous positive airway pressure (CPAP) treatment using a nasal mask. The five children in group A had nasal CPAP only in a hospital setting; the five children in group B received the treatment at home as well. Four of these five children, who have now been followed for as long as 10 months, have adapted well to the treatment at home. The problems encountered with nasal CPAP as a home treatment, such as poor cooperation from parents, allergic rashes, eye irritation resulting from air leaks, are discussed. Despite the problems, nasal CPAP is a valid alternative to tracheostomy in children as young as 3 years of age. MH - Child ; Child, Preschool ; Comparative Study ; Equipment Failure ; Evaluation Studies ; Female ; Follow-Up Studies ; Home Nursing ; Hospitalization ; Human ; Male ; Monitoring, Physiologic ; Positive Pressure Respiration/ADVERSE EFFECTS/INSTRUMENTATION/*METHODS ; Sleep Apnea Syndromes/*THERAPY SO - Pediatrics 1986 Nov;78(5):797-802 2 UI - 86321034 AU - Duncan AW ; Oh TE ; Hillman DR TI - PEEP and CPAP. AB - Positive end-expiratory pressure (PEEP) maintains airway pressure above atmospheric at the end of expiration, and may be used with mechanical ventilation or spontaneous breathing. CPAP, or continuous positive airway pressure, refers to spontaneous ventilation with a positive airway pressure being maintained throughout the whole respiratory cycle. PEEP/CPAP primarily improves oxygenation by increasing functional residual capacity, and may increase lung compliance and decrease the work of breathing. PEEP/CPAP may be applied using endotracheal tubes, nasal masks or prongs, or face masks or chambers to treat a wide range of adult and paediatric respiratory disorders. Complications associated with their use relate to the pressures applied and include pulmonary barotrauma, decreased cardiac output and raised intracranial pressure. MH - Airway Resistance ; Apnea/THERAPY ; Asthma/THERAPY ; Bronchiolitis, Viral/ THERAPY ; Burns, Inhalation/THERAPY ; Cardiovascular System/PHYSIOLOGY ; Heart Failure, Congestive/THERAPY ; Human ; Hyaline Membrane Disease/ THERAPY ; Infant, Newborn ; Intubation ; Kidney/PHYSIOLOGY ; Lung/ INJURIES ; Nomenclature ; Pneumonia/THERAPY ; Positive Pressure Respiration/ADVERSE EFFECTS/*METHODS ; Postoperative Period ; Pulmonary Edema/THERAPY ; Pulmonary Surfactants/METABOLISM ; Respiration ; Respirators ; Respiratory Distress Syndrome, Adult/PREVENTION & CONTROL/ THERAPY ; Review ; Sleep Apnea Syndromes/THERAPY ; Work of Breathing SO - Anaesth Intensive Care 1986 Aug;14(3):236-50 3 UI - 86321369 AU - Strohl KP ; Redline S TI - Nasal CPAP therapy, upper airway muscle activation, and obstructive sleep apnea. AB - In treating obstructive sleep apnea, positive pressure applied through the nose (CPAP) might cause a reflex increase in upper airway muscle activity or might enlarge the airway passively. We studied the effect of CPAP applied by a nasal mask on the electromyographic (EMG) activation of the alae nasi and genioglossal muscles in 8 patients with obstructive apneas during sleep, and correlated EMG activity with concentrations of oxygenation by ear oximeter, and with the end-expiratory position of the rib cage and abdomen by DC-coupled inductance plethysmography. One to 3 cm H2O of CPAP did not eliminate the cyclic occurrence of obstructive apneas. The greatest tonic and phasic EMG activity occurred at apnea termination; the least occurred at apnea onset. With 13 to 15 cm H2O CPAP, apneas were eliminated; mean oxygen saturation rose from 84 +/- 6% (mean +/- SD) to 92 +/- 2%, and EMG activity was reduced or eliminated. With abrupt lowering of CPAP, end-expiratory positions fell, and an obstructive apnea ensued; however, EMG activity did not immediately return. We conclude that the elimination of apneas with CPAP is not attributed to increased EMG activity in the upper airway. The reduction in EMG activity observed with nasal CPAP was closely related to the improvement in hemoglobin oxygen saturation. Therefore, CPAP may act as a pneumatic splint and passively open the upper airway to prevent obstructive apnea. MH - Electromyography ; Male ; Muscles/*PHYSIOPATHOLOGY ; Nose/ *PHYSIOPATHOLOGY ; Oxygen/BLOOD ; *Positive Pressure Respiration ; Pressure ; Sleep Apnea Syndromes/BLOOD/PHYSIOPATHOLOGY/*THERAPY ; Support, U.S. Gov't, P.H.S. ; Tongue/*PHYSIOPATHOLOGY SO - Am Rev Respir Dis 1986 Sep;134(3):555-8 4 UI - 86299759 AU - Sanders MH ; Gruendl CA ; Rogers RM TI - Patient compliance with nasal CPAP therapy for sleep apnea. AB - Continuous positive airway pressure via the nasal route (nasal CPAP) is effective in reducing the frequency of occlusive and mixed patterns of sleep apnea. Little is known about long-term patient compliance with this therapeutic modality, however. In order to evaluate this, questionnaires were mailed to 24 sleep apnea patients who had received a nasal CPAP system for nightly use. Patients were requested not to sign the questionnaire. At the time of mailing, the patients had possessed their nasal CPAP equipment for 10.3 +/- 8 months (mean +/- SD). Twenty patients (83 percent) responded to the questionnaire. Sixteen responders used nasal CPAP during all nightly sleep time, and two used it for all but one and 2.5 hours of nightly sleep time, respectively. One individual used it on alternate nights, and one patient did not use it all. Thus, 17 of 20 (85 percent) responders were compliant. Including information about the four nonresponders, obtained by means other than questionnaire, 18 of 24 (75 percent) patients were compliant with therapy. All but two patients were obese at the time sleep apnea was diagnosed. Only 50 percent of questionnaire responders reported weight loss after receiving nasal CPAP, and these individuals were frequent nasal CPAP users. The most common complaints were mask discomfort (14 responders) and nasal dryness and congestion (13 responders). We conclude that long-term home nasal CPAP is a viable therapy that is conscientiously applied and well-tolerated by most sleep apnea patients. MH - Adolescence ; Adult ; Aged ; Body Weight ; Human ; Middle Age ; *Patient Compliance ; *Positive Pressure Respiration ; Questionnaires ; Sleep Apnea Syndromes/*THERAPY ; Support, U.S. Gov't, Non-P.H.S. ; Time Factors SO - Chest 1986 Sep;90(3):330-3 5 UI - 86273498 AU - Rajagopal KR ; Bennett LL ; Dillard TA ; Tellis CJ ; Tenholder MF TI - Overnight nasal CPAP improves hypersomnolence in sleep apnea. AB - Eleven adult men with sleep apnea underwent nocturnal polysomnography on two successive nights. The first study, done without NCPAP, served as the control. The second (treatment) was done with the application of 7.5 to 15 cm H2O nasal continuous positive airway pressure (NCPAP). A subjective sleepiness index (SSI) was noted upon awakening from each night of polygraphic recording. During the control night, the mean frequency of apnea episodes/sleep hr was 35.95 +/- 4.5 SE, and the mean duration was 28.68 +/- 2.7 sec. Mean frequency of disorder of breathing (DOB) episodes/sleep hr was 19.25 +/- 6.2 and mean duration of DOB episodes was 23.1 +/- 2.8 sec. During the treatment night, all obstructive apnea episodes were abolished. During the control night, the mean decrease in arterial oxygen saturation during obstructive apnea episodes was 11.2 +/- 1.9 percent and the mean lowest saturation was 67.6 +/- 4.0 percent. NCPAP eliminated arterial oxygen desaturation. While 44.5 +/- 5.7 percent of total sleep time was spent in either apnea or disordered breathing during the control night, NCPAP decreased this to 0.73 +/- 0.3 percent. In addition to the improvement in respiration during sleep, SSI decreased from a mean of 3.73 +/- 0.49 after the control night to 1.64 +/- 0.24 after treatment, reflecting an improvement in daytime hypersomnolence. We conclude that nasal CPAP is effective in eliminating obstructive apnea episodes, and results in a marked decrease in daytime hypersomnolence after one treatment night. MH - Adult ; Aged ; Human ; Hypersomnia/*PREVENTION & CONTROL/PHYSIOPATHOLOGY ; Male ; Middle Age ; Oxygen/BLOOD ; *Positive Pressure Respiration ; Respiratory Function Tests ; Sleep Apnea Syndromes/PHYSIOPATHOLOGY/ *THERAPY ; Sleep Disorders/*PREVENTION & CONTROL ; Support, U.S. Gov't, Non-P.H.S. SO - Chest 1986 Aug;90(2):172-6 6 UI - 86273497 AU - Issa FG ; Sullivan CE TI - Reversal of central sleep apnea using nasal CPAP. AB - Based on the theory that obstructive (OSA) and central (CSA) sleep apneas share common pathophysiologic mechanisms, we attempted to treat eight patients with predominantly CSA by continuous positive airway pressure (CPAP). All patients exhibited repetitive episodes of CSA and mixed sleep apneas (MSA) in the supine position with a mean duration of 23.7 +/- 0.7 s and 34.5 +/- 1.3 s, respectively. The pattern of apnea changed when the subject lay in the lateral position. Five patients were observed to develop OSA in the lateral position with a mean duration of 27.2 +/- 1.5 s, while the other three patients snored continuously. High levels of CPAP (range 9.0 to 16.5 cm H2O) prevented all CSA and MSA and resulted in quiet breathing in all eight patients. Intermediate levels of CPAP produced firstly MSA, then purely OSA and/or continuous snoring. Low levels of nasal CPAP also prevented OSA and snoring occurring in the lateral posture in all subjects (range 2.0 to 8.3 cm H2O). Three patients are currently on home CPAP therapy for a range of four to 36 months. We conclude that upper airway collapse in the supine posture has a key role in the induction of CSA. We suggest that a reflex inhibition of respiration through activation of supraglottic mucosal receptors during passive oropharyngeal airway closure caused CSA in these patients. MH - Adult ; Aged ; Airway Resistance ; Anesthesia, Local ; Human ; Male ; Middle Age ; Oropharynx/DRUG EFFECTS ; *Positive Pressure Respiration ; Posture ; Respiratory Function Tests ; Sleep Apnea Syndromes/ETIOLOGY/ PHYSIOPATHOLOGY/*THERAPY ; Snoring/PHYSIOPATHOLOGY ; Support, Non-U.S. Gov't SO - Chest 1986 Aug;90(2):165-71 7 UI - 86191478 AU - Rapoport DM ; Garay SM ; Epstein H ; Goldring RM TI - Hypercapnia in the obstructive sleep apnea syndrome. A reevaluation of the "Pickwickian syndrome:. AB - The mechanisms of hypercapnia in eight patients with the "Pickwickian: syndrome and obstructive sleep apnea (OSAS) were evaluated pretherapy and posttherapy (tracheostomy in seven patients and chronic nocturnal use of nasal CPAP in one). Four patients (correctors) became eucapnic within two weeks of therapy. Four others (noncorrectors) remained hypercapnic. Neither residual apneas, changes in pulmonary function, change in anatomic dead space, nor changes in ventilatory chemoresponsiveness differentiated the two groups, nor did the last three factors account for return to eucapnia in the correctors. The results indicated two separate mechanisms exist for chronic hypercapnia in OSAS: a critical balance between the ventilation during the time spent awake and hypoventilation due to apneas, a mechanism removed by treatment for obstructive apnea; and sustained hypoventilation independent of the apnea phenomenon and therefore not correctible. The subset of patients with the second mechanism appears to represent the true "Pickwickian: syndrome and can be identified before therapy by measuring a low level of ventilation in the sustained awake state. MH - Aged ; Anoxia/PHYSIOPATHOLOGY ; Chronic Disease ; Comparative Study ; Human ; Hypercapnia/*ETIOLOGY/PHYSIOPATHOLOGY ; Middle Age ; Pickwickian Syndrome/*COMPLICATIONS/PHYSIOPATHOLOGY/THERAPY ; Positive Pressure Respiration ; Respiratory Function Tests ; Sleep/PHYSIOLOGY ; Sleep Apnea Syndromes/*COMPLICATIONS/PHYSIOPATHOLOGY/THERAPY ; Support, Non-U.S. Gov't ; Support, U.S. Gov't, P.H.S. ; Tracheotomy ; Ventilation-Perfusion Ratio SO - Chest 1986 May;89(5):627-35 1 UI - 86309941 AU - Caldarelli DD ; Cartwright R ; Lilie JK TI - Severity of sleep apnea as a predictor of successful treatment by palatopharyngoplasty. AB - As awareness and understanding of obstructive sleep apnea has increased so has the number of treatments for this disorder. Options include surgical procedures: tracheostomy, palatopharyngoplasty (PPP), and mandibular advancement. Other treatments are medication, nasal CPAP, Tongue Retaining Device, and a position alarm. With these numerous choices available, it is important that reliable indicators be developed to guide treatment choice. And although PPP surgery is a one-time intervention with possibility of permanent correction, reports of percentages of successful treatment have varied widely from 85% to 0%. This has led us to investigate predictors of successful treatment. Twenty-two patients treated with PPP following their diagnosis by standard clinical polysomnography were restudied an average of 8 weeks later. When 11 successful cases were compared to 11 unsuccessful cases, successes were found to be initially more severely apneic (mean AI = 90.55 versus 49.45). Palatopharyngoplasty appears to be most appropriate for the sleep apnea patient whose apnea index is 70 or above and less effective for milder cases. MH - Adult ; Aged ; Female ; Human ; Male ; Middle Age ; Palate/SURGERY ; Pharynx/SURGERY ; Sleep Apnea Syndromes/DIAGNOSIS/*SURGERY SO - Laryngoscope 1986 Sep;96(9 Pt 1):945-7 2 UI - 86081443 AU - Issa FG ; Sullivan CE TI - The immediate effects of nasal continuous positive airway pressure treatment on sleep pattern in patients with obstructive sleep apnea syndrome. AB - We studied the immediate effects of continuous positive airway pressure (CPAP) applied nasally on the pattern of sleep in 12 patients, aged 30-58 years, with obstructive sleep apnea syndrome. All patients demonstrated a moderate to severe syndrome on the control night; apnea index ranged 28-83 apneas/h sleep. Nasal CPAP completely abolished all obstructive apneas and allowed apnea-free breathing in all 12 patients. Nasal CPAP had a marked effect on the sleep pattern. It significantly reduced stage I/II non-rapid eye movement (NREM) sleep and markedly increased stage III/IV NREM and REM sleep on the first treatment night. Stage I/II NREM sleep decreased from a control of 62.7 +/- 2.3% to 29.1 +/- 2.3% on the first treatment night. Stage III/IV NREM sleep increased from a control of 6.7 +/- 1.6% to 31.5 +/- 1.6%. The rebound in this sleep stage was especially marked in 3 patients aged 55-58 years. REM sleep increased from a control of 18.4 +/- 2.0% to 30.6 +/- 2.0% on the first treatment night. There was an increase in REM density. All patients were treated for another 2 nights and their sleep pattern analyzed on the third night. All sleep stages were still significantly different to the control night. The possible mechanisms involved are discussed. MH - Adult ; Atmospheric Pressure ; Female ; Human ; Male ; Middle Age ; Movement ; Respiratory Airflow ; Sleep Apnea Syndromes/*THERAPY ; Sleep Stages/PHYSIOLOGY ; Sleep, REM/PHYSIOLOGY ; Support, Non-U.S. Gov't ; Wakefulness SO - Electroencephalogr Clin Neurophysiol 1986 Jan;63(1):10-7