Nasal EPAP

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Nasal EPAP

Nasal expiratory positive airway pressure (Nasal EPAP) is a treatment for obstructive sleep apnea (OSA) and snoring. [1] [2]

Contemporary EPAP devices have two small valves that allow air to be drawn in through each nostril, but not exhaled; the valves are held in place by adhesive tabs on the outside of the nose. [1] The mechanism by which EPAP may work is not clear; it may be that the resistance to nasal exhalation leads to a buildup in CO2 which in turn increases respiratory drive, or that resistance to exhalation generates pressure that forces the upper airway to open wider. [1]

In OSA it appears to be effective to reduce but not eliminate apnea for people with mild to moderate OSA (Apnea–hypopnea index < 30) and for people who cannot tolerate CPAP, but within those groups it is not clear why some respond and others do not, and the evidence consists of small clinical trials with follow-up no longer than one year. [1] [2] As of 2015 there was evidence from one small trial that it may be useful in children with OSA. [1] It has shown evidence of reducing snoring as well. [1] [2]

EPAP is unlikely to be effective in people with significant nasal obstruction. [1] Side effects that emerged during clinical trials included difficulty breathing, difficulty falling or staying asleep, dry mouth, nasal congestion, headache, difficulty putting on or removing the device, and anxiety. [1]

Ventus Medical received FDA 510K clearance for marketing the Provent EPAP device for OSA in 2009. [3] [4] Ventus received 510K clearance for an EPAP device to treat snoring in June 2012. [5] [6] Ventus was acquired by Theravent Inc. in 2013. [7] [8]

Related Research Articles

Sleep apnea Disorder involving pauses in breathing during sleep

Sleep apnea, also spelled sleep apnoea, is a sleep disorder in which pauses in breathing or periods of shallow breathing during sleep occur more often than normal. Each pause can last for a few seconds to a few minutes and they happen many times a night. In the most common form, this follows loud snoring. There may be a choking or snorting sound as breathing resumes. Because the disorder disrupts normal sleep, those affected may experience sleepiness or feel tired during the day. In children, it may cause hyperactivity or problems in school.

Sleep disorder Medical disorder of the sleep patterns of a person

A sleep disorder, or somnipathy, is a medical disorder of the sleep patterns of a person. Some sleep disorders are serious enough to interfere with normal physical, mental, social and emotional functioning. Polysomnography and actigraphy are tests commonly ordered for some sleep disorders.

Snoring Vibration of respiratory structures and the resulting sound due to obstructed air movement during breathing while sleeping

Snoring is the vibration of respiratory structures and the resulting sound due to obstructed air movement during breathing while sleeping. In some cases, the sound may be soft, but in most cases, it can be 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.

Apnea is the cessation of breathing. During apnea, there is no movement of the muscles of inhalation, and the volume of the lungs initially remains unchanged. Depending on how blocked the airways are, there may or may not be a flow of gas between the lungs and the environment; gas exchange within the lungs and cellular respiration is not affected. Voluntarily doing this is called holding one's breath. Apnea may first be diagnosed in childhood, and it is recommended to consult an ENT specialist, allergist or sleep physician to discuss symptoms; malformation and/or malfunctioning of upper airways may be observed by an orthodontist.

Obesity hypoventilation syndrome 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.

Positive airway pressure 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 is a sleep disorder characterized by the narrowing of the airway that can cause disruptions to sleep. The symptoms include unrefreshing sleep, fatigue or 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, orthodontics, surgery, or CPAP therapy. UARS is considered a variant of sleep apnea.

Polysomnography Multi-parametric test used in the study of sleep and as a diagnostic tool in sleep medicine

Polysomnography (PSG), a type of sleep study, is a multi-parametric test used in the study of sleep and as 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.

Mandibular advancement splint

A mandibular splint or mandibular 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.

Obstructive sleep apnea Obstruction of the upper airway during sleep

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 restorative 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.

Uvulopalatopharyngoplasty

Uvulopalatopharyngoplasty is a surgical procedure or sleep surgery used to remove tissue and/or remodel tissue in the throat. This could be because of sleep issues. Tissues which may typically be removed include:


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.

Somnoplasty® is a trademark by Somnus Medical Technologies used for its radiofrequency ablation medical devices cleared by the Food and Drug Administration (FDA) to treat habitual snoring, chronic nasal obstruction, and obstructive sleep apnea (OSA) to shrink the tissues that are causing obstruction. Somnoplasty is typically an outpatient procedure that takes 30–45 minutes.

Significant physiologic changes in breathing take place during normal sleep related to alterations in respiratory drive and musculature.

Continuous positive airway pressure Form of ventilator which applies mild air pressure continuously to keep airways open

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.

Catathrenia or nocturnal groaning is a sleep-related breathing disorder, consisting of end-inspiratory apnea and expiratory groaning during sleep. The name originates from the Greek kata (below) and threnia, and it describes a rare condition characterized by monotonous, irregular groans while sleeping. Catathrenia begins with a deep inspiration. The person with catathrenia holds her or his breath against a closed glottis, similar to the Valsalva maneuver. Expiration can be slow and accompanied by sound caused by vibration of the vocal cords or a simple rapid exhalation. Despite a slower breathing rate, no oxygen desaturation usually occurs. The moaning sound is usually not noticed by the person producing the sound, but it can be extremely disturbing to sleep partners. It appears more often during expiration REM sleep than in NREM sleep.

Central sleep apnea (CSA) or central sleep apnea syndrome (CSAS) is a sleep-related disorder in which the effort to breathe is diminished or absent, typically for 10 to 30 seconds either intermittently or in cycles, and is usually associated with a reduction in blood oxygen saturation. CSA is usually due to an instability in the body's feedback mechanisms that control respiration. Central sleep apnea can also be an indicator of Arnold–Chiari malformation.

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.

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.

Airway clearance therapy is treatment that uses a number of airway clearance techniques to clear the respiratory airways of mucus and other secretions. Several respiratory diseases cause the normal mucociliary clearance mechanism to become impaired resulting in a build-up of mucus which obstructs breathing, and also affects the cough reflex. Mucus build-up can also cause infection, and inflammation, and repeated infections can result in damage to the airways, and the lung tissue.

References

  1. 1 2 3 4 5 6 7 8 Wu, H; Yuan, X; Zhan, X; Li, L; Wei, Y (September 2015). "A review of EPAP nasal device therapy for obstructive sleep apnea syndrome". Sleep & Breathing. 19 (3): 769–74. doi:10.1007/s11325-014-1057-y. PMID   25245174. S2CID   23455608.
  2. 1 2 3 Riaz, M; et al. (2015). "Nasal Expiratory Positive Airway Pressure Devices (Provent) for OSA: A Systematic Review and Meta-Analysis". Sleep Disorders. 2015: 734798. doi: 10.1155/2015/734798 . PMC   4699057 . PMID   26798519.
  3. FDA ProVent 510K table
  4. FDA Provent 510(k) Summary April 3, 2009
  5. FDA InVent 510K table
  6. FDA InVent 510(k) Summary June 12, 2012
  7. Staff, Sleep Review. April 19, 2013 Ventus Medical Closing Its Doors
  8. Bloomberg Ventus profile Page accessed August 15, 2016

Further reading