Nasal continuous positive airway pressure (nCPAP) therapy in obstructive sleep breathing disorders

Abstract

The therapeutic efficacy and the incidence of significant side effects of nasal continuous positive airway pressure (nCPAP) treatment was investigated in 1140 patients with sleep-related apnoea (1089 men, 51 women; mean age 53.2 +/- 9.2 [16-84] years). All had been treated for the condition with nCPAP at the Marburg University Medical Polyclinic between 1986 and 1992. The mean number of attacks of apnoea and/or hypopnoea per hour of sleep ("respiratory disturbance index", RDI) was 45.8 +/- 25.6 before treatment and 3.5 +/- 4.8 under nCPAP. 21.1% of patients had an apnoea index of no more than 10/h. 11.6% an RDI of no more than 15/h. The average airway pressure was 8.7 (3-18) cm H2O. The treatment was successful in 1023 patients and these decided to continue the treatment long-term. The RDI could not be lowered under 10/h in 63 patients, while 4 patients declined ambulant treatment despite the demonstrated efficacy of nCPAP. Three patients developed acute left ventricular failure in the initial phase of the treatment, while in another 16 patients long-persisting central hypoventilation was shown to occur. These data show that treatment with nCPAP can be employed for all degrees of severity of obstructive sleep apnoea. However, because of the potentially life-threatening side effects, the introduction of the treatment must be undertaken in the sleep laboratory under continuous monitoring.