Positive Airway Pressure Treatment for Obstructive Sleep Apnea

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Positive Airway Pressure Treatment for Obstructive Sleep Apnea Kakkar Rahul K. , MD, FCCP, Berry Richard B. , MD, FCCP CHEST Volume 132, Issue 3, Pages 1057-1072 (September 2007) DOI: 10.1378/chest.06-2432 Copyright © 2007 The American College of Chest Physicians Terms and Conditions

Figure 1 Positive pressure modes: CPAP, bilevel PAP, and CPAP with expiratory pressure relief are illustrated. CHEST 2007 132, 1057-1072DOI: (10.1378/chest.06-2432) Copyright © 2007 The American College of Chest Physicians Terms and Conditions

Figure 2 An example of pressure vs time for APAP treatment over a night. The device titrated between upper and lower pressure limits set by the clinician. The average pressure is lower than an optimal fixed pressure. In this case, treatment with a fixed pressure would require a CPAP of 10 to 11 cm H2O. CHEST 2007 132, 1057-1072DOI: (10.1378/chest.06-2432) Copyright © 2007 The American College of Chest Physicians Terms and Conditions

Figure 3 A overnight pressure vs time tracing is shown for a patient using autobilevel PAP with a minimum EPAP of 6 cm H2O and a maximum IPAP of 25 cm H2O. The 90% IPAP and EPAP pressures were 19.2 cm H2O and 16.2 cm H2O, respectively. The average IPAP and EPAP values were 14.6 cm H2O and 11.8 cm H2O, respectively. CHEST 2007 132, 1057-1072DOI: (10.1378/chest.06-2432) Copyright © 2007 The American College of Chest Physicians Terms and Conditions

Figure 4 Examples of a nasal pillows mask (Swift; ResMed) [left] and a pillows oronasal mask (Hybrid; InnoMed Technologies; Coconut Creek, FL) [right]. CHEST 2007 132, 1057-1072DOI: (10.1378/chest.06-2432) Copyright © 2007 The American College of Chest Physicians Terms and Conditions

Figure 5 A 90-s tracing during a PAP titration. A period of increased leak (B) was associated with a drop in the CPAP flow signal. Note that the flow profile remains rounded in B unlike what is usually seen during obstructive hypopneas. With arousal (C), the leak suddenly dropped. There was minimal body movement from A to C (mask did not move). Video monitoring revealed a mouth opening during B (reprinted with permission from Berry RB, Sleep Medicine Pearls, second edition, Philadelphia, PA: Hanley and Belfus, 2003; 130). CHEST 2007 132, 1057-1072DOI: (10.1378/chest.06-2432) Copyright © 2007 The American College of Chest Physicians Terms and Conditions