Obstructive sleep apnea is readily reversible with nasally administered continuous positive airway pressure, although its effectiveness can be limited by poor patient compliance with therapy. With recent developments in technology, the ability to both diagnose and manage this disorder is dramatically improving. Assessment and therapeutic intervention can now be carried out not only in attended settings, such as sophisticated sleep laboratories, but in semiattended and unattended situations, including the home. What impact these advances will have on improving patient tolerance to therapy and reducing long-term clinical consequences of obstructive sleep apnea remains to be seen. However, there is no doubt that sleep-trained professionals now have many more tools at their disposal to diagnose and treat this disorder.
References
1.
CistulliPA, SulllivanCE. Pathophysiology of sleep apnea. In: SaundersNA, SullivanCE, eds. Sleep and Breathing. 2nd ed. New York: Marcel Dekker, 1994:405–48.
2.
HungJ, WhitfordEG, ParsonsRW, HillmanDR. Association of sleep apnoea with myocardial infarction in men. Lancet1990;336:261–4.
3.
KoskenvuoM, KaprioJ, TelakiviT, Snoring as a risk factor for ischaemic heart disease and stroke in men. Br Med J (Clin Res Ed)1987;294:16–9.
GouldGA, WhyteKF, RhindGB, The sleep hypopnea syndrome. Am Rev Respir Med1988;137:895–8.
11.
GuilleminaultC, StoohsR, DuncanS.Snoring (I): Daytime sleepiness in regular heavy snorers. Chest1991;99:40–8.
12.
GuilleminaultC, StoohsR, ClerkA, A cause of excessive daytime sleepiness: The upper airway resistance syndrome. Chest1993;104:781–7.
13.
YoungT, PeppardP, PaltaM, Population-based study of sleep-disordered breathing as a risk factor for hypertension. Arch Intern Med1997;157:1746–52.
14.
SullivanCE, IssaFG, Berthon-JonesM, EvesL.Reversal of obstructive sleep apnoea by continuous positive airway pressure applied through the nares. Lancet1981;1:862–5.
15.
RapoportDM. Methods to stabilize the upper airway using positive pressure. Sleep1996;19(9 Suppl):S123–30.
16.
WrightJ, JohnsR, WattI, Health effects of obstructive sleep apnoea and the effectiveness of continuous positive airways pressure: A systematic review of the research evidence. BMJ1997;314:851–60.
17.
EnglemanHM, MartinSE, DearyIJ, DouglasNJ. Effect of continuous positive airway pressure treatment on daytime function in sleep apnoea/hypopnoea syndrome. Lancet1994;343:572–5.
18.
BallesterE, BadiaJR, HernandezL, Evidence of the effectiveness of continuous positive airway pressure in the treatment of sleep apnea/hypopnea syndrome. Am J Respir Crit Care Med1999;159:495–501.
19.
EnglemanHM, KingshottRN, WraithPK, Randomized placebo-controlled crossover trial of continuous positive airway pressure for mild sleep Apnea/Hypopnea syndrome. Am J Respir Crit Care Med1999; 159:461–7.
20.
RedlineS, AdamsN, StraussME, Improvement of mild sleep-disordered breathing with CPAP compared with conservative therapy. Am J Respir Crit Care Med1998;157:858–65.
21.
MontserratJM, BallesterE, OliviH, Time-course of stepwise CPAP titration: Behavior of respiratory and neurological variables. Am J Respir Crit Care Med1995;152:1854–9.
22.
TeschlerH, Berthon-JonesM, ThompsonAB, Automated continuous positive airway pressure titration for obstructive sleep apnea syndrome. Am J Respir Crit Care Med1996;154:734–40.
23.
LloberesP, BallesterE, MontserratJM, Comparison of manual and automatic CPAP titration in patients with sleep apnea/hypopnea syndrome. Am J Respir Crit Care Med1996;154:1755–8.
24.
IssaFG, SullivanCE. The immediate effects of nasal continuous positive airway pressure treatment on sleep pattern in patients with obstructive sleep apnea syndrome. Electroencephalogr Clin Neurophysiol1986;63:10–7.
25.
TeschlerH, FarhatAA, ExnerV, AutoSet nasal CPAP titration: Constancy of pressure, compliance and effectiveness at 8 month follow-up. Eur Respir J1997;10:2073–8.
26.
KribbsNB, PackAl, KlineLR, Objective measurement of patterns of nasal CPAP use by patients with obstructive sleep apnea. Am Rev Respir Dis1993;147:887–95.
27.
HoffsteinV, VinerS, MateikaS, ConwayJ.Treatment of obstructive sleep apnea with nasal continuous positive airway pressure: Patient compliance, perception of benefits, and side effects. Am Rev Respir Dis1992;145:841–5.
28.
KriegerJ, KurtzD, PetiauC, Long-term compliance with CPAP therapy in obstructive sleep apnea patients and in snorers. Sleep1996;19(9 Suppl):S136–43.
29.
WaldhornRE, HerrickTW, NguyenMC, Long-term compliance with nasal continuous positive airway pressure of obstructive sleep apnea. Chest1990;97:33–8.
30.
MiljeteigH, HoffsteinV.Determinants of continuous positive airway pressure level for treatment of obstructive sleep apnea. Am Rev Respir Dis1993;147:1526–30.
31.
McNicholasWT, TarloS, ColeP, Obstructive apneas during sleep in patients with seasonal allergic rhinitis. Am Rev Respir Dis1982;126:625–8.
32.
CartwrightRD. Effect of sleep position on sleep apnea severity. Sleep1984;7:110–4.
33.
SullivanCE, GrunsteinRR. Continuous positive airway pressure in sleep-disordered breathing. In: KrygerMH, RothT, DementWC, eds. Principles and Practice of Sleep Medicine. Philadelphia: W.B. Saunders, 1989:559–70.
34.
SeriesF, MarcI, CormierY, La ForgeJ.Required levels of nasal continuous positive airway pressure during treatment of obstructive sleep apnoea. Eur Respir J1994;7:1776–81.
35.
EnglemanHM, MartinSE, DouglasNJ. Compliance with CPAP therapy in patients with the sleep apnoea/hypopnoea syndrome. Thorax1994;49:263–6.
36.
PepinJL, LegerP, VealeD, Side effects of nasal continuous positive airway pressure in sleep apnea syndrome: Study of 193 patients in two French sleep centers. Chest1995;107:375–81.
37.
RichardsGN, CistulliPA, UngarRG, Mouth leak with nasal continuous positive airway pressure increases nasal airway resistance. Am J Respir Crit Care Med1996;154:182–6.
38.
SandersMH, GruendlCA, RogersRM. Patient compliance with nasal CPAP therapy for sleep apnea. Chest1986;90:330–3.
MeuriceJC, MergyJ, RostykusC, Atrial arrhythmia as a complication of nasal CPAP. Chest1992;102:640–2.
41.
JarjourNN, WilsonP.Pneumocephalus associated with nasal continuous positive airway pressure in a patient with sleep apnea syndrome. Chest1989;96:1425–6.
42.
RauscherH, FormanekD, PoppW, ZwickH.Self-reported vs measured compliance with nasal CPAP for obstructive sleep apnea. Chest1993;103:1675–80.
43.
GrunsteinRR, DoddMJ, CostasL, SullivanCE. Home nasal CPAP for sleep apnea—acceptance of home therapy and its usefulness. Aust N Z J Med1986;16:635.
44.
RolfeI, OlsonLG, SaundersNA. Long-term acceptance of continuous positive airway pressure in obstructive sleep apnea. Am Rev Respir Dis1991;144:1130–3.
45.
MortimoreIL, BradleyPA, MurrayJA, DouglasNJ. Uvulopalatopharyngoplasty may compromise nasal CPAP therapy in sleep apnea syndrome. Am J Respir Crit Care Med1996;154:1759–62.
46.
KribbsNB, PackAI, KlineLR, Effects of one night without nasal CPAP treatment on sleep and sleepiness in patients with obstructive sleep apnea. Am Rev Respir Dis1993;147:1162–8.
47.
HersV, LiistroG, DuryM, Residual effect of nCPAP applied for part of the night in patients with obstructive sleep apnoea. Eur Respir J1997;10:973–6.
48.
ChervinRD, TheutS, BassettiC, AldrichMS. Compliance with nasal CPAP can be improved by simple interventions. Sleep1997;20:284–9.
49.
HoyCJ, VennelleM, KingshottRN, Can intensive support improve continuous positive airway pressure use in patients with the sleep apnea/hypopnea syndrome?Am J Respir Crit Care Med1999;159:1096–100.
50.
Reeves-HocheMK, MeckR, ZwillichCW. Nasal CPAP: An objective evaluation of patient compliance. Am J Respir Crit Care Med1994;149:149–54.
51.
Berthon-JonesM, LawrenceS, SullivanCE, GrunsteinR.Nasal continuous positive airway pressure treatment: Current realities and future. Sleep1996;19(9 Suppl):S 131–5.
52.
SchwartzAR, VeitCA, SchwartzJR. A comparative study of commercially available autotitrating devices for obstructive sleep apnea. Sleep1998;21:S94.
