Treatment of obstructive sleep apnea: the role of nasal continuous positive airway pressure
SUNIT R. PATEL, MD
JOSEPH A. GOLISH, MDAddress reprint requests to J.A.G., Department of Pulmonary and Critical Care Medicine, A90, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195.
KAY STELMACH, RN
Nasal continuous positive airway pressure (CPAP) has become the treatment of choice for the initial management of obstructive sleep apnea.KEY POINTS
Nasal CPAP is usually considered when a patient with obstructive sleep apnea has an apnea-hypopnea index (the mean number of episodes of apnea or hypopnea per hour of sleep) of greater than 20 or if the index is between 5 and 20 and the patient has significant daytime sleepiness or has cardiovascular risk factors such as hypertension, hyper-cholesterolemia, cigarette smoking, or obesity. The optimum pressure for the individual patient should be determined in a sleep laboratory. Many patients do not actually use CPAP as directed (all night, every night); newer machines, counseling, and measures to reduce side effects may improve compliance. During the first few nights of CPAP therapy, as the patient sleeps more soundly, the risk of apnea and hypoxemia may actually increase; thereafter, the pattern of sleep returns to normal.