An apnea is a brief pause in breathing. These pauses often occur during sleep. When they lead to repeated arousals and daytime sleepiness, a diagnosis of sleep apnea is warranted. A 2010 survey in "Journal of Clinical Sleep Medicine" indicates 17 percent of older adults may have sleep apnea. Fortunately, several treatment options exist for this sleep disorder. The most effective option is positive airway pressure. In this therapy, air is pushed through the nose or mouth using a special machine. This technique can be done in several ways.
Continuous Positive Airway Pressure
The most popular form of apnea treatment is continuous positive airway pressure, or CPAP. With CPAP therapy, a constant stream of air is supplied to the patient. The airway is sealed at either the nose or mouth using a tight-fitting mask. This seal creates a slight pressure forcing the airway to remain open.
A 2010 review published in the "Indian Journal of Medical Research" evaluated several forms of respiratory therapy. Although newer options are available, the authors conclude that CPAP remains the treatment of choice for sleep apnea. Relatedly, a 2006 paper in the "Cochrane Database of Systematic Reviews" shows that CPAP therapy is more effective than dental devices. It increases nighttime sleep, decreases daytime sleepiness, and improves life quality. CPAP also reduces the high blood pressure commonly found in apnea patients.
Bilevel Positive Airway Pressure
A newer form of positive airway pressure is called bilevel positive airway pressure, or BPAP. This therapy is similar to CPAP and uses the same equipment. However, with BPAP treatment, the patient experiences a greater pressure when they inhale than when they exhale. This change puts less burden on the airway, and it improves compliance.
A 2008 investigation in the journal "Chest" studied BPAP and CPAP therapy in sleep apnea subjects with heart failure. Such patients, unfortunately, are not rare given the stress on the body caused by repeated apneaic events. The data show that BPAP was superior to CPAP in improving cardiac health. Other studies have also found BPAP to be superior, yet more research is needed before firm conclusions can be drawn.
Autotitrating Positive Airway Pressure
Some CPAP and BPAP machines now include an autotitration option. The use of this option is often called autotitrating positive airway pressure, or APAP. It uses a computer contained within the air-generating machine to calculate the appropriate pressure settings for each patient. The computer can also determine the number of apnea events and provide supplemental data.
A 2010 study in the periodical "Lung" compared APAP and CPAP in sleep apnea patients. The primary outcome measure was heart rate variability. Apneaics often exhibit large fluctuations in heart rate across the night due to their disturbed breathing and sleep. Results indicated that both APAP and CPAP therapy reduced apneas and arousals. Yet only CPAP improved heart rate variability. Thus the APAP technology is emerging and not yet completely refined.
References
- "Journal of Clinical Sleep Medicine"; Sleep Disturbances, Quality of Life, and Ethnicity: The Sleep Heart Health Study; C. M. Balwin et al.; April 15, 2010
- "Indian Journal of Medical Research"; Continuous Positive Airway Pressure Therapy: New Generations; J. F. Garvey et al.; February 2010
- "Cochrane Database of Systematic Reviews"; Continuous Positive Airways Pressure for Obstructive Sleep Apnoea in Adults; T. L. Giles et al.; July 19, 2006
- "Chest"; Cardiac Effects of Continuous and Bilevel Positive Airway Pressure for Patients with Heart Failure and Obstructive Sleep Apnea: A Pilot Study; Khayat et al.; December 2008
- "Lung"; Improving Heart Rate Variability in Sleep Apnea Patients: Differences in Treatment with Auto-titrating Positive Airway Pressure (APAP) Versus Conventional CPAP; L. Karasulu et al.; April 7, 2010
