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CPAP therapy for respiratory insufficiency is an established and accepted mode of therapy; however, patient compliance remains an issue. Recent studies have shown that high-flow therapy (HFT), which uses high flows of warmed and humidified air/O2 mixtures through a nasal cannula, can also be effective in treating respiratory insufficiency. Although a nasal cannula is commonly preferred over a CPAP mask, patient comfort with HFT and CPAP has not been measured empirically. We sought to examine the autonomic neurophysiologic responses as a measure of comfort between these therapies.

In the last 20 years, most sleep apnea patients have been treated more or less with one individual but constant level of continuous positive airway pressure (CPAP). New insights into CPAP- and bilevel PAP-therapy employing auto CPAP (APAP) devices might change our attitude. Readings of the pressure profiles from APAPs teach us that the needed pressure levels are constantly changing during the night and on a day-to-day basis as the patient's daily performance and alcohol consumption change too. A new approach to CPAP therapy is discussed.

Introduction Current recommendations suggest CPAP treatment in patients with OSA and excessive daytime sleepiness. The Mosaic trial showed a reduction in Epworth Sleepiness Score (ESS) in minimally symptomatic patients although there was no change in cardiovascular risk. However, patients with significant co-morbidities and objective evidence of severe OSA are often treated. The treatment compliance of patients with a normal ESS is not well established. We reviewed compliance with CPAP therapy in patients with OSA with an ESS Methods Review of CPAP compliance on the Sleep medicine database in patients diagnosed with OSA and ESS Results 86 patients with OSA and ESS 4 h with a mean ESS change from 5.5 to 1.1. 14 (24%) patients using CPAP Conclusion Over two-third of patients with low ESS and symptoms/significant co-morbidities were compliant with CPAP therapy. All patients had improvement in ESS on treatment. A trial of treatment in this group of patients with a low ESS appears to be worthwhile.

Introduction and Objectives Obstructive sleep apnoea (OSA) is common and most patients are relatively young. CPAP is the standard treatment. This questionnaire survey aimed to improve the understanding of the problems which patients on CPAP face during travel and while away from home. Methods 150 patients on CPAP were randomly selected from our patient database and sent a postal questionnaire. They were asked the number of times they had travelled in the last 2 years and specific questions about the last three trips. These included mode of travel, duration of trip, change in CPAP use, problems with transport and use of CPAP. Patients were asked to specifically document whether they used CPAP during travel. All patients are offered a letter regarding their CPAP therapy to facilitate travel. Results 101 questionnaires were returned (men=69, mean age=60.5 years). 58 (men=50, mean age 59.4 years) had travelled in the last 2 years on 211 occasions. Data were collected for 139 trips. In 13 trips the CPAP machine was not taken. Reasons included weight, space and check in concerns. 84 trips were within Europe and 7 to North America. 93 trips were by air. On 22 trips, respondents reported the “CPAP letter” was needed for check in. In 7 of the 93 trips by air, problems with checking in the CPAP machine were encountered. In all but 4 trips the CPAP machine was carried as hand luggage. In 33 trips problems with use of CPAP due to the short power cord was reported. CPAP was used less often abroad. CPAP was rarely used during travel. Individual statements highlighted problems with security and check-in. Conclusions Patients with OSA travel abroad frequently and usually take their CPAP machine with them. In a significant number there are problems with check-in of the CPAP machine and we strongly recommend patients are provided with a “CPAP letter”. Improved dissemination of information is needed to patients and airport staff regarding OSA and CPAP. We recommend patients carry extension cords and power adaptors. The reason for less use of CPAP abroad is not clear and needs further explanation.

In a prospective study, we assessed the effect of CPAP therapy on the insulin sensitivity and CV risk factors such as blood pressure (BP), glycaemia status, and lipid profile in patients with obstructive sleep apnoea (OSA). Only patients with confirmed presence of cardinal features and diagnostic apnoea/hypopnoea index (AHI) for OSA were enrolled in the study. All patients were studied before the initiation of CPAP therapy. Following an initial screening visit before CPAP treatment, patients were then studied at 6 and 12 weeks following the initiation of CPAP. We studied 41 patients with confirmed OSA, aged 56 ± 13 (mean ± SD) years, 33 male and 8 female, who had their weight, BP and fasting blood samples checked in a screening visit and two study visits, at least 6 weeks apart. The fasting blood samples were used to assess fasting plasma glucose, HbA 1c , fasting insulin, lipid profile, and CRP. Following CPAP treatment baseline systolic BP had significantly improved compared to BP following CPAP therapy (135 ± 17 vs 123 ± 12 mm Hg, p=0.001) and so did diastolic BP (83 ± 9 vs 77 ± 9 mm Hg, p=0.01). There were also improvement in fasting plasma glucose (5.6 ± 1.7 vs 4.9 ± 2.0 mmol/l, p>0.05) and HbA 1c (5.8 ± 1.3 vs 5.4 ± 1.7%, p>0.05), but that was not statistically significant. There had been non-significant improvement of fasting insulin level (17.9 ± 25 vs 12.7 ± 15.5 pmol/l, p>0.05), but no improvement on insulin sensitivity. Lipid profile had also improved, as total cholesterol was decreased (5.2 ± 2.0 vs 4.8 ± 1.9 mmol/l, p>0.05), and so did triglycerides (2.7 ± 4.4 vs 2.0 ± 2.0 mmol/l, p>0.05), but these changes were not statistically significant. CRP had also improved but that was not statistically significant (4.5 ± 10 vs 2.4 ± 2.0 mg/l, p>0.05). In conclusion, this study demonstrates that CPAP therapy in patients with OSA can result in significant improvement in systolic and diastolic BP, as well as non-significant improvement in lipid profile and glycaemia status.

Background Previous studies have reported a higher incidence of diastolic dysfunction indices in obstructive sleep apnoea (OSA). Chronic diastolic dysfunction causes structural and functional remodelling of left atrium resulting in increase in left atrial volume (LAV). Long-term continuous positive airway pressure (CPAP), an accepted treatment for OSA, has been shown to lead to improvement in diastolic function in OSA. However, it is still not known if long term CPAP treatment causes reduction in LAV (representing chronic diastolic dysfunction) in such patients. Methods Accordingly, a total of 27 patients with moderate to severe OSA (aponea-hypopnoea index>15) were recruited. All patients underwent 3D echocardiography (3DE) for end-systolic LA volume calculation prior to CPAP treatment. LA volume was also calculated using conventional 2D echocardiography (2DE) methods (ie, elliptical and biplane area length). All OSA patients were then treated by CPAP (>20 weeks). 3DE and 2DE LAV measurements were repeated following successful CPAP treatment. Results Mean duration of CPAP therapy was 20 weeks. Significant reduction in LAV was noted by all three methods following CPAP therapy (abstract 088 table 1). Conclusion Long term successful CPAP treatment results in significant reduction in LAV, a marker for adverse prognosis, determined by 3D and 2DE techniques.

The purpose of this report is to introduce a new therapy technique for treating hypernasality. The instrumentation consists of a continuous positive airway pressure (CPAP) device that delivers air pressure by means of a hose and nasal mask assembly to the nasal cavities. This positive pressure is theoretically useful in providing resistance training to strengthen the velopharyngeal closure muscles. Speech drillwork is conducted in the patient's home and consists of production of VNCV syllables and short sentences with the nasal mask worn by the patient. Incremental changes in CPAP pressure and time per therapy session occur over an 8-week course of therapy. Six case studies are presented. The preliminary results suggest that CPAP therapy may be effective in reducing hypernasality in individuals exhibiting mild to moderate degrees of severity.

To the Editors: In a recent editorial in the European Respiratory Journal , K.A. Franklin criticised the screening of heart failure patients for sleep-disordered breathing (SDB) 1. The major concern was that, to date, no beneficial effect on overall prognosis has been shown for any therapeutic option, e.g. nocturnal oxygen, continuous positive airway pressure (CPAP) or adaptive servoventilation (ASV). The Canadian Continuous Positive Airway Pressure for Patients with Central Sleep Apnea and Heart Failure (CANPAP) trial was the first study to assess the effect of CPAP therapy …

increases in sympathetic activity. However, previous studies on antihypertensive effects of CPAP therapy have yielded inconsistent results. We postulated that good CPAP compliance is needed for BP reduction. Objective: To examine the effect of CPAP on BP in OSAHS patients and compare the outcomes based on CPAP compliance. Methods: A retrospective review of patients diagnosed to have OSAHS during the period September 2003 to June 2005 was performed. These patients were divided into two groups based on CPAP compliance. Consistent users (CG) reported daily CPAP usage while intermittent users (IG) skipped CPAP use one or more nights each week. Daytime systolic (SBP), diastolic (DBP) and mean arterial BP (MAP) were measured before and after 11 months’ CPAP use. Hypertensive patients were excluded if their anti-hypertensive regimens were changed. Paired T test was used to test for differences. Data are presented as mean values ± SD. Results: Forty patients were consistent CPAP users while 34 used CPAP intermittently (3.7 ± 1.9 days per week). Among CG patients, SBP decreased significantly from 138 ± 17.9 mm Hg to 127 ± 15.6 mm Hg (p < 0.01), DBP reduced from 83.2 ± 11.4 mm Hg to 76.5 ± 9.9 mm Hg (p < 0.01) and MAP reduced from 101 ± 12.6 mm Hg to 93.6 ± 10.7 mm Hg (p < 0.01). Among IG patients, SBP remained unchanged (133 ± 15.1 mmHg at baseline and 130 ± 15 mm Hg after CPAP, p = 0.35), DBP decreased significantly from 85.1 ± 9.4 mmHg to 81.1 ± 8.1 mm Hg (p = 0.01) and MAP decreased from 101 ± 9.8 mm Hg to 97.6± 9.8 mm Hg (p = 0.03). SBP reduction was significantly greater among CG patients compared to IG patients (p = 0.02). Conclusion: This retrospective review showed that daytime DBP and MAP of OSAHS patients were reduced after 11 months’ CPAP usage in both groups of patients while SBP was reduced among consistent CPAP users. Regularity of CPAP usage was the sole criterion for good compliance in this study as hours of CPAPusagemight be overestimated in subjective reporting. Prospective studies using objective monitoring of hours of CPAP used at effective pressure are needed to further evaluate the importance of CPAP compliance on BP reduction.

연구배경 : 폐쇄성 수면 무호흡 증후군 환자는 수면중에 전신성 혈압의 상승과 심박동수의 현저한 변화를 보이며, 이러한 심혈관계 기능변화는 수면중 반복되는 무호흡에 의한 저산소증과 각성반응으로 인한 교감신경계 활성도 변화와 관련이 있을 것으로 생각되고 있다. 지속적 기도 양압 공급(CPAP) 치료는 폐쇄성 수면 무호흡을 가장 확실하게 치료할 수 있는 방법으로 알려져 있으나 이러한 치료법이 환자들의 심혈관계 교감신경계 활성도에 어떠한 영향을 미치는 지에 대해서는 명확히 알려져 있지 않다. 이에 저자들은 폐쇄성수면 무호흡 증후군 환지에서 CPAP 치료 적용시 나타나는 심혈관계 및 교감신경계 활성도 변화를 관찰하고자하였다. 방법 : 수면다원검사에서 폐쇄성 수면 무호흡 증후군으로 진단되어 CPAP 치료를 시행한 13명을 대상으로 치료 전과 후의 수면다원검사의 각 지표, 수면중 전신성 혈압, 수면중 심박동수와 부정맥, 그리고 혈장 catecholamines 농도 변화를 비교 분석하였다. 결과 : 수면다원검사의 각 지표중 CPAP 치료 후 무호흡-저호흡지수는 유의하게 감소하였고(p 【Background : Obstructive sleep apnea syndrome (OSAS) affects systemic blood pressure and cardiac function. The development of cardiovascular dysfunction including the changes of systemic blood pressure and cardiac rhythm, suggests that recurrent hypoxia and arousals from sleep may increase a sympathetic nervous system activity. Continuous positive airway pressure (CPAP) therapy has been found to be an effective treatment of OSAS. However, only a few studies have investigated the cardiovascular and sympathetic effects of CPAP therapy. We evaluated influences of nasal CPAP therapy on the cardiovascular system and the sympathetic activity in patients with OSAS. Methods : Thirteen patients with OSAS underwent CPAP therapy and were monitored using polysomnography, blood pressure, heart rate, presence of arrhythmia and the concentration of plasma catecholamines, before and with CPAP therapy. Results: The apnea-hypopnea index (AHI) was significant1y decreased (p】

To investigate the efficacy of extubation at higher levels of continuous positive airway pressure (CPAP), 49 newborns (0.95 to 4.0 kg) were extubated at 2 to 3 cm H2O following 1 to 47 days of CPAP therapy. Pre- and post-extubation measurements of PO2, PCO2, pH, FiO2, and CPAP were made in all infants. No significant differences (P < .05) were found between pre- and post-extubation arterial blood gas values for all patients. Comparison of pre- and post-extubation blood gas data with respect to birthweight (< 2.0 kg vs. > 2.0 kg) and intubation time (< 8 days vs. > 8 days) also indicated no statistical differences. Mean alveolar-arterial oxygen differences and FiO2 for 41 infants showed progressive decreases following extubation. Six of the 49 infants required reintubation within 72 hours following extubation. The results of this study indicate that newborns with respiratory disease requiring CPAP may be extubated at 2 to 3 cm H2O with no significant changes in arterial blood gas values, thus preventing prolonged intubation associated with weaning to 0 cm H2O CPAP.

Background Obstructive sleep apnea (OSA) is one of the possible causes of atrial fibrillation (AF). Continuous positive airway pressure (CPAP) therapy may lower the recurrence rate of AF after cardioversion to normal sinus rhythm. We report a case of AF caused by OSA and successfully converted by CPAP therapy. Case A 65-year-old man presented with AF of unidentified causes. After severe OSA was diagnosed, he was treated with CPAP for 2 months and his cardiac rhythm returned to sinus rhythm without any antiarrhythmic drugs or cardioversion. Conclusion AF caused by OSA may be converted to sinus rhythm by CPAP treatment.

To summarize, it can be stated that the CPAP-test is, so to speak, a therapy ‘ex juvantibus’ and enables an exact indication for the application of the CPAP-therapy. In our experience the CPAP-test is positive in several respiratory disorders of the newborn, not only in the RDS. Probably, the basis of all these disorders is a functional R-L shunt, and in all these disorders the CPAP-therapy is indicated.

During a 20-month period, 20 infants with idiopathic respiratory distress syndrome (IRDS) were treated with continuous positive airway pressure (CPAP) when they required at least 40% inspired oxygen. The infants were allocated to monitoring with either repeated blood-gas determinations according to the usual practice or continuous transcutaneous Po2 measurements supplemented by blood-gas measurements only when judged necessary. The groups were comparable with regard to birth weight and gestational age, and did not differ significantly with regard lo effectiveness or duration of the CPAP treatment, survival rates (90 versus 80%) or number of complications. None developed retrolental fibroplasia. However, Ptco2 monitoring resulted in significantly less hypo- and hyperoxaemia and the number of blood-gas analyses performed during CPAP therapy amounted to only 0.6 per infant per day in the transcutaneously monitored group as against 5.3 in the other group. We propose that Ptco2 monitoring should now be the method of choice and that the use of umbilical artery catheterization should be restricted to selected groups of very low birth-weight infants and to infants in need of ventilator therapy.

Heart failure is often accompanied by sleep disorders. CPAP therapy has proven in the treatment of obstructive sleep apnea, but the benefits associated with comorbid patients and patients with heart failure is still under research. On the other hand, central sleep apnea is also with high frequency in these patients and more difficult to treat. The aim of the current publication is to make a brief review of acute and exacerbated chronic heart failure in patients with sleep disorders - frequency, severity, and types to treat.

The aim of our study is to determine association between obstructive sleep apnea (OSA) syndrome and levels of blood coagulation markers and evaluate possible effects of continuous positive airway pressure (CPAP) therapy. Materials and methods. We included 74 middle-aged (mean age 48 [40; 55] years) male patients with arterial hypertension (AH) of average duration 8 [5; 10] years without antiplatelet, anticoagulant therapy and diabetes mellitus. All patients underwent sleep breathing study. According to the severity of OSA, patients were divided into 2 groups: 40 patients with severe OSA - apnea/hypopnea index - AHI 50.2 (37.8; 75.2) and control group with 34 patients with mild or no OSA - AHI 4.8 (2.6; 7.8). In all patients were analyzed markers of hemostasis system and parameters of whole blood viscosity; 34 patients with severe OSA underwent 3-4 nights of effective CPAP therapy (with achievement AHI

CPAP improves PaO2 in HMD, but usually is not applied until 70-80% O2 is required. Fourteen prematures met strict x-ray and clinical criteria for HMD and were paired by weight and severity of disease. Each infant was placed in 40% O2 until the PaO2 fell below 60 mmHg, when one of each pair (Group A) was immediately provided nasal CPAP. The other in the pair (Group B) was continued on to 70% O2 as necessary. CPAP was begun when the PaO2 again fell below 60 mmHg. All Group B infants qualified for CPAP. The onset of CPAP therapy averaged 7 hrs later in Group B. There was no significant difference between the two groups in morbidity, mortality or duration of O2 exposure. CPAP caused no rise in PaCO2 in either group. The average duration of CPAP for Group A was 58 hrs and 73 hrs for Group B (P > .05). Group A never required greater than 50% O2 during CPAP. Group B infants generally required 80% O2 at some time and remained over 70% an average of 33 hrs. Infants who cried during nasal CPAP exhibited dramatic transient falls in PaO2 and PaCO2 as well as wide fluctuations in pressure. By 5 hrs of age, 7 of 8 cases under 2000 gms. had a PaO2 < 60 mmHg in 40% O2, and 7 had x-rays characterized by reticulo-granularity, air bronchograms and indistinct heart borders. Early use of CPAP in this study was not associated with an increased incidence of complications, did lessen the severity but not the duration of the disease, and avoided the necessity of exposure to high levels of environmental oxygen.