Continuous positive airway pressure

The main therapy for obstructive sleep apnea is nasal continuous positive airway pressure (CPAP) therapy because of its effectiveness. 

FIGURE 38-1. Primary assessment and initial treatment for complaint of excessive daytime sleepiness. RLS, restless-legs syndrome NPSG, nocturnal polysomnography OSA, obstructive sleep apnea DA, dopamine agonist MSLT, multiple sleep latency test BZDRA, benzodiazepine receptor agonist SNRI, serotonin and norepinephrine reuptake inhibitor TCA, tricyclic antidepressant CPAP, continuous positive airway pressure. 

CPAP Continuous positive airway pressure EGD Esophagogastroduodenoscopy... 

Continuous positive airway pressure Therapy delivered using a nasal mask to improve the patency of the upper airway by maintaining sufficient air pressure to alleviate sleep-disordered breathing. 

Mineral Oil Hydraulic Fluids. No specific methods were located for interfering with the mechanism of action for toxic effects produced by mineral oil hydraulic fluids. Unstable alveoli and distal airways have been proposed as major factors in the respiratory symptoms that occur after the ingestion of other petroleum-derived materials. Continuous positive airway pressure or continuous negative chest wall pressure, as well as the application of supplemental oxygen, have been recommended to counteract the resultant pneumonitis (Eade et al. 1974 Klein and Simon 1986). 

The therapy for IRDS includes mechanical ventilation with continuous positive airway pressure. This maintains adequate ventilation and prevents airway collapse between breaths with the formation of atelectasis. Therapy also includes administration of exogenous pulmonary surfactant. Two types of surfactants are used to prevent and treat IRDS in the U.S. These include surfactants prepared from animal sources as well as synthetic surfactants. Exogenous pulmonary surfactants are administered as a suspension (in saline) through the endotracheal tube used for mechanical ventilation. 

FIGURE 72-1. Algorithm for treatment of dyssomnias. (BZDRA, benzodiazepine receptor agonist CPAP, continuous positive airway pressure.) (Adapted and reprinted with permission from Jermain DM, Sleep disorders. IntJann M, ed. Pharmacotherapy Self-Assessment Program, 2nd ed. Kansas City, MO, American College of Clinical Pharmacy, 1995 139-154.)... 

Patients suspected of having sleep apnea should undergo a sleep study. If sleep apnea is diagnosed, these patients should be treated with weight reduction, a continuous positive airway pressure (CPAP) machine, and, in extreme cases, surgery. Sleep apnea patients in general should not be prescribed sedative-hypnotics. 

Bradley TD, Logan AG, Kimoff RJ, et al. Continuous positive airway pressure for central sleep apnea and heart failure. N EnglJ Med. Nov 10 2005 353(19) 2025-2033. 

Naughton MT, Liu PP, Bernard DC, et al. Treatment of congestive heart failure and Cheyne-Stokes respiration during sleep by continuous positive airway pressure. Am J Respir Crit Care Med. Jan 1995 151(l) 92-97. 

Tkacova R, Liu PP, Naughton MT, et al. Effect of continuous positive airway pressure on mitral regurgitant fraction and atrial natriuretic peptide in patients with heart failure. JAm Coll Cardiol. Sep 1997 30(3) 739-745. 

CPAP (continuous positive airway pressure) device—A mask worn over the nose during sleep that constantly and gently pumps air through the nasal passages to prevent sleep apnea. 

Nasal continuous positive airway pressure produced improvement. 

Different lines of treatment for sleep disorders associated with EDS, such as continuous positive airway pressure or airway surgery, were evaluated using the MSLT. In comparing pre- and posttreatment symptoms, a subject may perceive an improvement of awareness as very substantial, whereas the MSLT may reveal that the vulnerability remains. Hence, objective assessment of the response is offered by the MSLT (16,54). The alerting effect of caffeine has been proven by its ability to increase the sleep latency on the MSLT of normal sleep-deprived subjects (55). 

Some of the respiratory disturbances experienced by Parkinson s patients are similar in nature to that experienced by non-Parkinson s patients with sleep-related respiratory disturbances. Hence the same treatments may be used in both patient groups, depending on the stage of the Parkinson s. Continuous positive airway pressure (CPAP) can improve sleep in Parkinson s patients, but is not suitable during the advanced stages of Parkinson s. Alternatively, upper-airway surgery may provide some relief. Neither of these measures, however, alleviates the respiratory disturbance that may be due to the muscle rigidity associated directly with Parkinson s disease. 

Brain K, Thornton JG, Sarkar A, Johnson AOC. Obstructive sleep apnoea and fetal death successful treatment with continuous positive airway pressure. Br J Obstet Gynecol 2001 108 543-544. 

Edwards N, Blyton DM, Kirjavainen T, Kesby GJ, Sullivan CE. Nasal continuous positive airway pressure reduces sleep-induced blood pressure increments in preeclampsia. Am J Respir Crit Care Med 2000 162 252-257. 

Means MK, Lichstein KL, Edinger JD, et al. Changes in depressive symptoms after continuous positive airway pressure treatment for obstructive sleep apnea. Sleep Breath 2003 7(1) 31—42. 

Krieger J, Meslier N, Lebrun T, et al. Accidents in obstructive sleep apnea patients treated with nasal continuous positive airway pressure a prospective study. The Working Group ANTADIR, Paris and CRESGE, Lille, France. Association Nationale de Traitement a Domicile des Insuffisants Respiratoires. Chest 1997 112 1561-1566. 

Marin JM, Carrizo SJ, Vicente E, Agusti AGN (2005) Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure an observational study. The Lancet 365(9464) 1046-1053... 

Grunstein RR (2005) Chapter 89 - Continuous Positive Airway Pressure Treatment for Obstructive Sleep Apnea-Hypopnea Syndrome, Principles and Practice of Sleep Medicine, 4th edition ed. Elsevier Saunders, Philadelphia... 

Yokoe T, Minoguchi K, Matsuo H, Oda N, Minoguchi H, Yoshino G, Hirano T, Adachi M (2003) Elevated levels of C-reactive protein and interleukin-6 in patients with obstructive sleep apnea syndrome are decreased by nasal continuous positive airway pressure. 

Nelesen RA, Yu H, Ziegler MG, Mills PJ, Clausen JL, Dimsdale JE (2001) Continuous positive airway pressure normalizes cardiac autonomic and hemodynamic responses to a laboratory stressor in apneic patients. Chest 119 1092-1101... 

Black JE, Hirshkowitz M (2005) Modafinil for treatment of residual excessive sleepiness in nasal continuous positive airway pressure-treated obstructive sleep apnea/hypopnea syndrome. Sleep 28 464-471... 

Naughton MT, Benard DC, Rutherford R, Bradley TD (1994) Effect of continuous positive airway pressure on central sleep apnea and nocturnal PC02 in heart failure. Am JRespir Crit Care Med 150(6 Pt 1) 1598-1604... 

Naughton MT, Rahman M A, Hara K, Floras JS, Bradley TD (1995) Effect of continuous positive airway pressure on intrathoracic and left ventricular transmural pressures in patients with congestive heart failure. Circulation 91 1725-1731... 

Bradley TD, Holloway RM, McLaughlin PR, Ross BL, Walters J, Liu PP (1992) Cardiac output response to continuous positive airway pressure in congestive heart failure. Am Rev RespirDis 145(2 Pt 1) 377-382... 

Sin DD, Logan AG, Fitzgerald FS, Liu PP, Bradley TD (2000) Effects of continuous positive airway pressure on cardiovascular outcomes in heart failure patients with and without Cheyne-Stokes respiration. Circulation 102 61-66... 

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