Advancements of CPAP Therapy for Obstructive Sleep Apnea

Abstract

Continuous positive airway pressure (CPAP), the gold standard for the treatment of patients with obstructive sleep apnea (OSA) syndrome, was introduced by Sullivan in 1981. CPAP acts as an air splinter to support the collapsing upper airway during sleep. The mask, the interface between CPAP and the patient, plays a major role in patient acceptance and compliance with treatment. Improvements in mask materials, design, and aerodynamics have over time continued to increase patient compliance in the use of CPAP. Optimized pressure titration and mask fitting, as well as educational programs, are key factors that have increased the likelihood of CPAP acceptance, as well as teamwork between experienced technicians and enthusiastic physicians. The numerous potential side effects of CPAP, which include nasal and flow-related problems, skin abrasion, and humidifier issues, can be resolved with appropriate and frequent supervision during the early phase of treatment and including regular long-term reviews. CPAP can improve the cardiovascular, neurocognitive, and renal hepatic consequences of OSA, thus improving longevity and quality of life as well as reducing daytime somnolence. When compared with the recent technique of auto-titrating CPAP (APAP), traditional fixed-pressure CPAP has also been proven to be well accepted in appropriately selected patients. Patient compliance and improvement in daytime sleepiness favor APAP, but fixed-pressure CPAP provides a higher oxygen saturation during sleep. In conclusion, CPAP is the most accepted treatment modality for OSA, but to achieve higher patient acceptance rates and better compliance, research needs to continue into the facial apparatus and delivery methods of the oxygen.