Nasal continuous positive airway pressure in the treatment of obstructive sleep apnea

Nasal continuous positive airway pressure (CPAP) effectively treats obstructive sleep apnea by providing a pneumatic splint in the supraglottic airway. This treatment involves administration of a constant positive end-expiratory pressure (PEEP) within the range of 2.5 to 17.5 cm H₂O. The optimal PEEP not only eliminates apneas and hypopneas, but also consolidates sleep. Establishing the optimal PEEP requires Polysomnographic monitoring of the patient during REM and NREM states as well as all sleep positions. The most common adverse effects are nasal dryness, nasal congestion, rhinorrhea, and sneezing. Room air humidification reduces nasal irritation and dryness; some models of CPAP equipment are adaptable to allow placement of a humidifier in the system. Long-term compliance with CPAP was studied in a survey of 121 patients who underwent a CPAP trial. After 6 months, 74.4% were compliant; after 18 months 66.6% reported compliance. Patients tended toward greater compliance when they received regular follow-up care by a physician with significant experience with this treatment modality.