New developments in the use of positive airway pressure for obstructive sleep apnea

Abstract

Obstructive sleep apnea (OSA) is a disorder which afflicts a large number of individuals around the world. OSA causes sleepiness and is a major cardiovascular risk factor. Since its inception in the early 1980's, continuous positive airway pressure (CPAP) has emerged as the major treatment of OSA, and it has been shown to improve sleepiness, hypertension, and a number of cardiovascular indices. Despite its successes, adherence with treatment remains a major limitation. Herein we will review the evidence behind the use of positive airway pressure (PAP) therapy, its various modes, and the methods employed to improve adherence. We will also discuss the future of PAP therapy in OSA and personalization of care.

Keywords: Obstructive sleep apnea (OSA); positive airway pressure (PAP); treatment adherence.

Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1

Representative photo of CPAP in place on a mannequin. (A) CPAP blower unit which creates pressure gradient; (B) CPAP tubing which transmits pressure to the mask; (C) CPAP mask which is applied firmly to the patient and provides positive pressure to the upper airway. CPAP, continuous positive airway pressure.

Figure 2

Effect of positive airway pressure on cross sectional upper airway anatomy. (Schwab et al., AJRCCM, 1996; reprinted with permission of the American Thoracic Society. Copyright© 2014 American Thoracic Society) (5).

Figure 3

Representative airflow tracing with pressure time tracings of CPAP, CPAP with expiratory pressure relief (EPR), and bi-level positive airway pressure (BPAP). EPR decreases applied pressure level during exhalation in a flow-dependent manner. BPAP provides a fixed inspiratory pressure and a fixed expiratory pressure. CPAP, continuous positive airway pressure.

Figure 4

Representative masks. (A) Nasal pillows mask; (B) nasal mask; (C) oronasal mask.