[Effectiveness of nasal CPAP-treatment (continuous positive airway pressure)].
Nasal continuous positive airway pressure (n-CPAP) is an effective treatment for the obstructive sleep apnea syndrome (OSAS). It is currently regarded as the first line therapy for OSAS. The principal indication for n-CPAP treatment is daytime sleepiness. Nasal-CPAP improves daytime sleepiness dramatically in severe cases and the effect is objectively measurable with the multiple sleep latency test (MSLT). It is noteworthy that n-CPAP also improves symptoms, subjective daytime sleepiness, cognitive function, IQ, mood, quality of life and driving ability already in patients with mild sleep apnea with an apnea/hypopneaindex (AHI) between 5 and 15 per hour of sleep during overnight polysomnography. Although not yet 100% robust, there is clear evidence that patients with OSAS have an increased frequency of systemic hypertension. Some early and imperfect studies suggest that CPAP reduces cardiovascular and cerebrovascular outcomes; however unequivocal evidence that n-CPAP reduces mortality is still awaited. There is now good evidence that treatment with n-CPAP reduces the two- to sevenfold increased risk of road accidents of untreated patients with OSAS. In summary, there exists abundant evidence today that n-CPAP is an efficient therapy for symptomatic patients with the obstructive sleep apnea syndrome. A trial with n-CPAP is therefore justified in all symptomatic patients. Based on the large number of randomized controlled trials of n-CPAP a therapeutic trial is indicated even in only mildly symptomatic patients with OSAS. Nasal-CPAP use and outcomes of therapy can be improved by provision of an intensive CPAP-education and support program.
Gugger
M
M
Pneumologische Abteilung, Universitätskliniken, Inselspital, Bern. mgugger@insel.ch
Bassetti
C
C
D000063:Accidents, Traffic / Q000517:prevention & control; D006970:Disorders of Excessive Somnolence / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D006973:Hypertension / Q000517:prevention & control; D011175:Positive-Pressure Respiration / Q000009:adverse effects / Q000379:methods*; D016032:Randomized Controlled Trials as Topic; D020181:Sleep Apnea, Obstructive / Q000628:therapy*; D020521:Stroke / Q000517:prevention & control; D016896:Treatment Outcome