CPAP continuous positive airway pressure

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

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. 

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. 

Modafinil is itself an adjunct to standard treatments for obstructive sleep apnea/hypopnea syndrome (OSAHS) if continuous positive airway pressure (CPAP) is the treatment of choice, a maximal effort to treat first with CPAP should be made prior to initiating modafinil and CPAP should be continued after initiation of modafinil... 

Removal from exposure and airway support with adequate ventilation are the priorities. Pulmonary oedema should be treated with continuous positive airway pressure (CPAP) or, in severe cases, with mechanical ventilation and positive end expiratory pressure (PEEP). 

In this mode, the ventilator maintains a positive pressure at the airway as the patient attempts to inspire. Figure 18.6 illustrates a typical airway pressure waveform during continuous positive airway pressure (CPAP) breath delivery. The therapist sets the sensitivity level lower than PEEP. The sensitivity is the pressure level that the patient has to attain by making an effort to breathe. This, in turn, triggers the ventilator to deliver a spontaneous breath by supplying air (or a mixture of air and oxygen) to raise the pressure back to the PEEP level. Typically, the PEEP and sensitivity levels are selected such that the patient will be impelled to exert effort to breathe independently. As in the case of the mandatory mode, when the patient exhales, the ventilator shuts off the flow of gas and opens the exhalation valve to allow the patient to exhale into the atmosphere. 

Continuous positive airway pressure (CPAP) A spontaneous ventilation mode in which the ventilator maintains a constant positive pressure, near or below PEEP level, in the patient s airway while the patient breathes at will. 

Susceptibility factors Preterm infants Of7629 preterm and term infants admitted to the Neonatal Unit of the Royal Women s Hospital between 2001 and 2008, the 411 infants who received their first immunizations in hospital were both very preterm and of extremely low birth weights (<1000g) [2 ]. There was post-immunization apnea in 22 infants of sufficient severity to warrant the introduction of either intermittent positive pressure ventilation (two cases) or continuous positive airway pressure (CPAP) (20 cases). Infants with respiratory deterioration after immunization had a higher incidence of previous septicemia. 

Ventilators are either negative-pressure or positive-pressure. Negative-pressure ventilation involves directing air directly into the lungs, and positive-pressure ventilation involves directing air into the trachea. Some ventilators require intubation, the placement of a tube into the trachea from the nose or mouth. Ventilation requiring intubation is typically used for patients who will require ventilation for a protracted period. Other ventilators work with a breathing mask that can be placed over the mouth and nose. With the increase in respiratory-related sleep disorders (such as obstructive sleep apnea), use of two positive airway pressure systems—continuous positive airway pressure (CPAP) and bilevel positive pressure ventilators (BiPAP)—has become very common. 

Obstruction of the upper or lower airways may cause an increase in respiratory load. Obstructive sleep apnea (OSA) is less common in children than in adults. In this age group, enlarged tonsils and adenoids play a predominant role (3). Noninvasive continuous positive airway pressure (CPAP) ventilation has proved its efficacy and is proposed as a first therapeutic option if tonsillectomy and adenoidectomy are not able to relieve upper airway obstruction (4,5). Congenital abnormalities of the upper airways, such as laryngomalacia, tracheomalacia, or Pierre Robin syndrome, may also cause severe upper airway obstruction (6). Even in young infants, noninvasive CPAP may correct the alveolar hypoventilation (7). 

DP Kuehn. Continuous positive airway pressure (CPAP) in the treatment of hypernasality. Available at http //www.asel.udel.edu/icslp/cdrom/vol2/422/ a422 (cited August 26, 2002). 

---