Continuous positive airway pressure

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Continuous positive airway pressure
CPAP.png
Equipment for CPAP therapy: flow generator, hose, mask

Continuous positive airway pressure (CPAP) is a form of positive airway pressure (PAP) ventilation in which a constant level of pressure greater than atmospheric pressure is continuously applied to the upper respiratory tract of a person. The application of positive pressure may be intended to prevent upper airway collapse, as occurs in obstructive sleep apnea, or to reduce the work of breathing in conditions such as acute decompensated heart failure. CPAP therapy is highly effective for managing obstructive sleep apnea. Compliance and acceptance of use of CPAP therapy can be a limiting factor, with 8% of people stopping use after the first night and 50% within the first year. [1]

Contents

Medical uses

Moderate to severe obstructive sleep apnea

CPAP is the most effective treatment for moderate to severe obstructive sleep apnea, in which the mild pressure from the CPAP prevents the airway from collapsing or becoming blocked. [1] [2] CPAP has been shown to be 100% effective at eliminating obstructive sleep apneas in the majority of people who use the therapy according to the recommendations of their physician. [1] In addition, a meta-analysis showed that CPAP therapy may reduce erectile dysfunction symptoms in male patients with obstructive sleep apnea. [3]

Upper airway resistance syndrome

Upper airway resistance syndrome is another form of sleep-disordered breathing with symptoms that are similar to obstructive sleep apnea, but not severe enough to be considered OSA. CPAP can be used to treat UARS as the condition progresses, in order to prevent it from developing into obstructive sleep apnea. [4] [5] [6]

Pre-term infants

CPAP also may be used to treat pre-term infants whose lungs are not yet fully developed. For example, physicians may use CPAP in infants with respiratory distress syndrome. It is associated with a decrease in the incidence of bronchopulmonary dysplasia. In some preterm infants whose lungs have not fully developed, CPAP improves survival and decreases the need for steroid treatment for their lungs. In resource-limited settings where CPAP improves respiratory rate and survival in children with primary pulmonary disease, researchers have found that nurses can initiate and manage care with once- or twice-daily physician rounds. [7]

Asthma

CPAP can be used for the treatment of obstructive pulmonary diseases including asthma. [8] [9]

COVID-19

In March 2020, the USFDA suggested that CPAP devices may be used to support patients affected by COVID-19; [10] however, they recommended additional filtration since non-invasive ventilation may increase the risk of infectious transmission. [11]

Other uses

CPAP also has been suggested for treating acute hypoxaemic respiratory failure in children. However, due to a limited number of clinical studies, the effectiveness and safety of this approach to providing respiratory support is not clear. [12]

Contraindications

CPAP cannot be used in the following situations or conditions: [13]

Adverse effects

Some people experience difficulty adjusting to CPAP therapy and report general discomfort, nasal congestion, abdominal bloating, sensations of claustrophobia, mask leak problems, and convenience-related complaints. [1] Oral leak problems also interfere with CPAP effectiveness. [14]

Mechanism

CPAP therapy uses machines specifically designed to deliver a flow of air at a constant pressure. CPAP machines possess a motor that pressurizes room temperature air and delivers it through a hose connected to a mask or tube worn by the patient. This constant stream of air opens and keeps the upper airway unobstructed during inhalation and exhalation. [1] Some CPAP machines have other features as well, such as heated humidifiers.

The therapy is an alternative to positive end-expiratory pressure (PEEP). Both modalities stent open the alveoli in the lungs and thus recruit more of the lung surface area for ventilation. However, while PEEP refers to devices that impose positive pressure only at the end of the exhalation, CPAP devices apply continuous positive airway pressure throughout the breathing cycle. Thus, the ventilator does not cycle during CPAP, no additional pressure greater than the level of CPAP is provided, and patients must initiate all of their breaths. [15]

An example of a nasal mask for CPAP Depiction of a Sleep Apnea patient using a CPAP machine.png
An example of a nasal mask for CPAP
CPAP setup for adults in a low resource setting

Method of delivery of CPAP

Nasal CPAP

Nasal prongs or a nasal mask is the most common modality of treatment. [13] Nasal prongs are placed directly in the person's nostrils. A nasal mask is a small mask that covers the nose. There are also nasal pillow masks which have a cushion at the base of the nostrils, and are considered the least invasive option. [16] Frequently, nasal CPAP is used for infants, although this use is controversial. Studies have shown nasal CPAP reduces ventilator time, but an increased occurrence of pneumothorax also was prevalent. [17]

Nasopharyngeal CPAP

Nasopharyngeal CPAP is administered by a tube that is placed through the person's nose and ends in the nasopharynx. [13] This tube bypasses the nasal cavity in order to deliver the CPAP farther down in the upper respiratory system.

Face mask

A full face mask over the mouth and nose is another approach for people who breathe out of their mouths when they sleep. [13] Often, oral masks and naso-oral masks are used when nasal congestion or obstruction is an issue.[ medical citation needed ] There are also devices that combine nasal pressure with mandibular advancement devices (MAD).

Example of a full face mask CPAP Full face cpap mask.jpg
Example of a full face mask CPAP

Compliance

A large portion of people do not adhere to the recommended method of CPAP therapy, with more than 50% of people discontinuing use in the first year. [1] A significant change in behaviour is required in order to commit to long-term use of CPAP therapy and this can be difficult for many people, [1] since CPAP equipment must be used consistently for all sleep (including naps and overnight trips away from home) and needs to be regularly maintained and replaced over time. In addition, people with moderate to severe obstructive sleep apnea have a higher risk of concomitant symptoms such as anxiety and depression, which can make it more difficult to change their sleep habits and to use CPAP on a regular basis. [1] Educational and supportive approaches have been shown to help motivate people who need CPAP therapy to use their devices more often. [1]

History

Dr. Colin Sullivan, an Australian physician and professor, invented CPAP in 1980 at Royal Prince Alfred Hospital in Sydney. [18] Gerald McGinnis, founder of Respironics, began selling one of the first commercially available CPAP machines in 1985. [19]

See also

Related Research Articles

<span class="mw-page-title-main">Sleep apnea</span> Disorder involving pauses in breathing during sleep

Sleep apnea is a sleep-related breathing disorder in which repetitive pauses in breathing, periods of shallow breathing, or collapse of the upper airway during sleep results in poor ventilation and sleep disruption. Each pause in breathing can last for a few seconds to a few minutes and occurs many times a night. A choking or snorting sound may occur as breathing resumes. Common symptoms include daytime sleepiness, snoring, and non restorative sleep despite adequate sleep time. Because the disorder disrupts normal sleep, those affected may experience sleepiness or feel tired during the day. It is often a chronic condition.

Respironics is an American medical supply company owned by Philips that specializes in products that improve respiratory functions. It is based in the Pittsburgh suburb of Murrysville in Pennsylvania, United States.

<span class="mw-page-title-main">Snoring</span> Vibratory sound made while asleep

Snoring is the vibration of respiratory structures and the resulting sound due to obstructed air movement during breathing while sleeping. The sound may be soft or loud and unpleasant. Snoring during sleep may be a sign, or first alarm, of obstructive sleep apnea (OSA). Research suggests that snoring is one of the factors of sleep deprivation.

<span class="mw-page-title-main">Obesity hypoventilation syndrome</span> Condition in which severely overweight people fail to breathe rapidly or deeply enough

Obesity hypoventilation syndrome (OHS) is a condition in which severely overweight people fail to breathe rapidly or deeply enough, resulting in low oxygen levels and high blood carbon dioxide (CO2) levels. The syndrome is often associated with obstructive sleep apnea (OSA), which causes periods of absent or reduced breathing in sleep, resulting in many partial awakenings during the night and sleepiness during the day. The disease puts strain on the heart, which may lead to heart failure and leg swelling.

<span class="mw-page-title-main">Positive airway pressure</span> Mechanical ventilation in which airway pressure is always above atmospheric pressure

Positive airway pressure (PAP) is a mode of respiratory ventilation used in the treatment of sleep apnea. PAP ventilation is also commonly used for those who are critically ill in hospital with respiratory failure, in newborn infants (neonates), and for the prevention and treatment of atelectasis in patients with difficulty taking deep breaths. In these patients, PAP ventilation can prevent the need for tracheal intubation, or allow earlier extubation. Sometimes patients with neuromuscular diseases use this variety of ventilation as well. CPAP is an acronym for "continuous positive airway pressure", which was developed by Dr. George Gregory and colleagues in the neonatal intensive care unit at the University of California, San Francisco. A variation of the PAP system was developed by Professor Colin Sullivan at Royal Prince Alfred Hospital in Sydney, Australia, in 1981.

Upper airway resistance syndrome (UARS) is a sleep disorder characterized by the narrowing of the airway that can cause disruptions to sleep. The symptoms include unrefreshing sleep, fatigue, sleepiness, chronic insomnia, and difficulty concentrating. UARS can be diagnosed by polysomnograms capable of detecting Respiratory Effort-related Arousals. It can be treated with lifestyle changes, functional orthodontics, surgery, mandibular repositioning devices or CPAP therapy. UARS is considered a variant of sleep apnea, although some scientists and doctors believe it to be a distinct disorder.

<span class="mw-page-title-main">Cervical collar</span> Medical device used to support a neck

A cervical collar, also known as a neck brace, is a medical device used to support and immobilize a person's neck. It is also applied by emergency personnel to those who have had traumatic head or neck injuries, although they should not be routinely used in prehospital care. They can also be used to treat chronic medical conditions.

<span class="mw-page-title-main">Polysomnography</span> Multi-parameter study of sleep and sleep disorders

Polysomnography (PSG), a type of sleep study, is a multi-parameter study of sleep and a diagnostic tool in sleep medicine. The test result is called a polysomnogram, also abbreviated PSG. The name is derived from Greek and Latin roots: the Greek πολύς, the Latin somnus ("sleep"), and the Greek γράφειν.

<span class="mw-page-title-main">Mandibular advancement splint</span>

A mandibi splint or mandibi advancement splint is a prescription custom-made medical device worn in the mouth used to treat sleep-related breathing disorders including: obstructive sleep apnea (OSA), snoring, and TMJ disorders. These devices are also known as mandibular advancement devices, sleep apnea oral appliances, oral airway dilators, and sleep apnea mouth guards.

<span class="mw-page-title-main">Non-invasive ventilation</span> Breathing support administered through a face mask

Non-invasive ventilation (NIV) is the use of breathing support administered through a face mask, nasal mask, or a helmet. Air, usually with added oxygen, is given through the mask under positive pressure; generally the amount of pressure is alternated depending on whether someone is breathing in or out. It is termed "non-invasive" because it is delivered with a mask that is tightly fitted to the face or around the head, but without a need for tracheal intubation. While there are similarities with regard to the interface, NIV is not the same as continuous positive airway pressure (CPAP), which applies a single level of positive airway pressure throughout the whole respiratory cycle; CPAP does not deliver ventilation but is occasionally used in conditions also treated with NIV.

<span class="mw-page-title-main">Obstructive sleep apnea</span> Sleeping and breathing disorder

Obstructive sleep apnea (OSA) is the most common sleep-related breathing disorder and is characterized by recurrent episodes of complete or partial obstruction of the upper airway leading to reduced or absent breathing during sleep. These episodes are termed "apneas" with complete or near-complete cessation of breathing, or "hypopneas" when the reduction in breathing is partial. In either case, a fall in blood oxygen saturation, a disruption in sleep, or both, may result. A high frequency of apneas or hypopneas during sleep may interfere with the quality of sleep, which – in combination with disturbances in blood oxygenation – is thought to contribute to negative consequences to health and quality of life. The terms obstructive sleep apnea syndrome (OSAS) or obstructive sleep apnea–hypopnea syndrome (OSAHS) may be used to refer to OSA when it is associated with symptoms during the daytime.

Hypopnea is overly shallow breathing or an abnormally low respiratory rate. Hypopnea is defined by some to be less severe than apnea, while other researchers have discovered hypopnea to have a "similar if not indistinguishable impact" on the negative outcomes of sleep breathing disorders. In sleep clinics, obstructive sleep apnea syndrome or obstructive sleep apnea–hypopnea syndrome is normally diagnosed based on the frequent presence of apneas and/or hypopneas rather than differentiating between the two phenomena. Hypopnea is typically defined by a decreased amount of air movement into the lungs and can cause oxygen levels in the blood to drop. It commonly is due to partial obstruction of the upper airway.

Fisher & Paykel Healthcare Corporation Limited (FPH) is a manufacturer, designer and marketer of products and systems for use in respiratory care, acute care, and the treatment of obstructive sleep apnea. Based in New Zealand, their products and systems are sold in around 120 countries worldwide. FPH is primarily an exporting company, with just 1 percent of revenue coming from New Zealand sales.

Colin Sullivan is an Australian physician, professor, and inventor known for his invention of the nasal continuous positive airway pressure (CPAP) machine for the treatment of sleep apnea.

<span class="mw-page-title-main">Heated humidified high-flow therapy</span> Respiratory support method

Heated humidified high-flow therapy, often simply called high flow therapy, is a type of respiratory support that delivers a flow of medical gas to a patient of up to 60 liters per minute and 100% oxygen through a large bore or high flow nasal cannula. Primarily studied in neonates, it has also been found effective in some adults to treat hypoxemia and work of breathing issues. The key components of it are a gas blender, heated humidifier, heated circuit, and cannula.

Nasal expiratory positive airway pressure is a treatment for obstructive sleep apnea (OSA) and snoring.

Sleep surgery is a surgery performed to treat sleep disordered breathing. Sleep disordered breathing is a spectrum of disorders that includes snoring, upper airway resistance syndrome, and obstructive sleep apnea. These surgeries are performed by surgeons trained in otolaryngology, oral maxillofacial surgery, and craniofacial surgery.

Bubble CPAP is a non-invasive ventilation strategy for newborns with infant respiratory distress syndrome (IRDS). It is one of the methods by which continuous positive airway pressure (CPAP) is delivered to a spontaneously breathing newborn to maintain lung volumes during expiration. With this method, blended and humidified oxygen is delivered via short binasal prongs or a nasal mask and pressure in the circuit is maintained by immersing the distal end of the expiratory tubing in water. The depth to which the tubing is immersed underwater determines the pressure generated in the airways of the infant. As the gas flows through the system, it "bubbles" out and prevents buildup of excess pressures.

Oral pressure therapy (OPT) is a treatment for obstructive sleep apnea (OSA) that uses negative pressure in the mouth to shift the soft palate and tongue forward. The negative pressure is created by a bedside console connected by a small tube to a mouthpiece worn inside the mouth during sleep. The device is successful in between a quarter and a third of people.

<span class="mw-page-title-main">Glossary of breathing apparatus terminology</span> Definitions of technical terms used in connection with breathing apparatus

A breathing apparatus or breathing set is equipment which allows a person to breathe in a hostile environment where breathing would otherwise be impossible, difficult, harmful, or hazardous, or assists a person to breathe. A respirator, medical ventilator, or resuscitator may also be considered to be breathing apparatus. Equipment that supplies or recycles breathing gas other than ambient air in a space used by several people is usually referred to as being part of a life-support system, and a life-support system for one person may include breathing apparatus, when the breathing gas is specifically supplied to the user rather than to the enclosure in which the user is the occupant.

References

  1. 1 2 3 4 5 6 7 8 9 Askland, Kathleen; Wright, Lauren; Wozniak, Dariusz R.; Emmanuel, Talia; Caston, Jessica; Smith, Ian (April 2020). "Educational, supportive and behavioural interventions to improve usage of continuous positive airway pressure machines in adults with obstructive sleep apnoea". The Cochrane Database of Systematic Reviews. 2020 (4): CD007736. doi:10.1002/14651858.cd007736.pub3. ISSN   1469-493X. PMC   7137251 . PMID   32255210.
  2. ↑ Werman, Howard A.; Karren, K; Mistovich, Joseph (2014). "Continuous Positive Airway Pressure(CPAP)". In Werman A. Howard; Mistovich J; Karren K (eds.). Prehospital Emergency Care, 10e. Pearson Education, Inc. p. 242.
  3. ↑ Yang, Zhihao; Du, Guodong; Ma, Lei; Lv, Yunhui; Zhao, Yang; Yau, Tung On (February 2021). "Continuous positive airway pressure therapy in obstructive sleep apnoea patients with erectile dysfunction-A meta-analysis". The Clinical Respiratory Journal. 15 (2): 163–168. doi:10.1111/crj.13280. ISSN   1752-699X. PMID   32975905. S2CID   221917475. Archived from the original on 2021-04-23. Retrieved 2021-03-11.
  4. ↑ de Godoy, Luciana B.M.; Palombini, Luciana O.; Guilleminault, Christian; Poyares, Dalva; Tufik, Sergio; Togeiro, Sonia M. (January 2015). "Treatment of upper airway resistance syndrome in adults: Where do we stand?". Sleep Science. 8 (1): 42–48. doi: 10.1016/j.slsci.2015.03.001 . ISSN   1984-0063. PMC   4608900 . PMID   26483942.
  5. ↑ "Treatments". stanfordhealthcare.org. Archived from the original on 2021-05-11. Retrieved 2021-05-11.
  6. ↑ Repasky, David (2021-03-03). "CPAP Machine: How It Works, Reasons, and Uses". CPAP.com. Archived from the original on 2020-09-27. Retrieved 2021-05-11.
  7. ↑ Patrick, Wilson; Moresky, Rachel; Baiden, Frank; Brooks, Joshua; Morris, Marilyn; Giessler, Katie; Punguyire, Damien; Apio, Gavin; Agyeman-Ampromfi, Akua; Lopez-Pintado, Sara; Sylverken, Justice; Nyarko-Jectey, Kwadwo; Tagbor, Harry (June 2017). "Continuous positive airway pressure for children with undifferentiated respiratory distress in Ghana: an open-label, cluster, crossover trial" (PDF). Lancet Global Health. 5 (6): e615–e623. doi: 10.1016/S2214-109X(17)30145-6 . PMID   28495265.
  8. ↑ Schwerin, DL; Goldstein, S (2023-03-07). "EMS Prehospital CPAP Devices". StatPearls. PMID   29262140 . Retrieved 26 March 2024.
  9. ↑ Millard, Elizabeth (2023-09-11). "Can CPAP Be Used to Treat Asthma?". HealthCentral. Retrieved 26 March 2024.
  10. ↑ "Ventilator Supply Mitigation Strategies: Letter to Health Care Providers". U.S. Food and Drug Administration. FDA. Archived from the original on 30 March 2020. Retrieved 30 March 2020.
  11. ↑ "COVID-19 resources for anesthesiologists". asahq.org. American Society of Anesthesiologists (ASA). Archived from the original on 30 March 2020. Retrieved 30 March 2020.
  12. ↑ Shah, Prakeshkumar S.; Ohlsson, Arne; Shah, Jyotsna P. (2013-11-04). "Continuous negative extrathoracic pressure or continuous positive airway pressure compared to conventional ventilation for acute hypoxaemic respiratory failure in children". The Cochrane Database of Systematic Reviews. 2013 (11): CD003699. doi:10.1002/14651858.CD003699.pub4. ISSN   1469-493X. PMC   6464907 . PMID   24186774.
  13. 1 2 3 4 Pinto, Venessa L.; Sharma, Sandeep (2020), "Continuous Positive Airway Pressure (CPAP)", StatPearls, Treasure Island (FL): StatPearls Publishing, PMID   29489216, archived from the original on 2020-11-11, retrieved 2020-09-02
  14. ↑ Genta, Pedro R.; Lorenzi-Filho, Geraldo (April 2018). "Sealing the Leak". Chest. 153 (4): 774–775. doi: 10.1016/j.chest.2017.10.023 . PMID   29626967.
  15. ↑ Werman, Howard A.; Karren, K; Mistovich, Joseph (2014). "Continuous Positive Airway Pressure(CPAP)". In Werman A. Howard; Mistovich J; Karren K (eds.). Prehospital Emergency Care, 10e. Pearson Education, Inc.
  16. ↑ "Slide show: Which CPAP masks are best for you?". Mayo Clinic. Archived from the original on 2021-05-11. Retrieved 2021-05-11.
  17. ↑ Morley, C. J.; Davis, P. G.; Doyle, L. W.; Brion, L. P.; Hascoet, J. M.; Carlin, J. B.; Coin Trial, I. (2008). "Nasal CPAP or Intubation at Birth for Very Preterm Infants" (PDF). New England Journal of Medicine. 358 (7): 700–708. doi:10.1056/NEJMoa072788. PMID   18272893. Archived (PDF) from the original on 2020-04-16. Retrieved 2019-06-28.
  18. ↑ "How the CPAP machine beats deadly sleep apnoea". The University of Sydney. Archived from the original on 2 February 2024. Retrieved 2 February 2024.
  19. ↑ "Philips recall crisis casts shadow over legacy of Respironics founder". Pittsburgh Post-Gazette. 30 December 2023. Archived from the original on 2 February 2024. Retrieved 2 February 2024.


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