Murray and Nadel Ch 122 Sleep Disordered Breathing Treatment

• related: Sleep and Sleep Disordered Breathing
• tags: #literature

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Overview

OSA Treatment

a. positive pressure b. positional device c. nasal bypass d. continuous negative external pressure therapy e. nasal resistance device f. weight loss g. mandibular advancement device h. oral pressure device i. tongue retaining device

Positive airway pressure

• CPAP: one pressure
• APAP: one pressure but can change throughout the night. Use for simple OSA. Don't use for comorbidities (respiratory failure or heart failure)
• APAP can result in sleep disruption
• APAP does not work for CSA but only responds to upper airway respiratory events
• automatic PAP (APAP) and auto-bilevel PAP (auto-BPAP) senses flow, resistance and adjusts pressure automatically.
• BPAP has either spontaneous mode or spontaneous timed mode (S vs ST)
• BPAP has lower expiratory pressure compared to APAP and can be used as alternative for pressure intolerance or aerophagia
• VAPS: volume assured pressure support

• CPAP = EPAP = PEEP; PS = IPAP − EPAP; Pmax = EPAPmax + PSmax = IPAPmax
• EPAP targets apnea. IPAP targets hypopnea

Central Sleep Apnea Treatment

CPAP

• CPAP can improve PCO2 slightly by helping VQ mismatch and reducing LV afterload
  • CPAP improves LV afterload by preventing upper airway collapse
• CPAP does not improve survival benefit in heart failure patients.
  • CANPAP trial CPAP does not improve mortality for patients with central sleep apnea and HFrEF?

Bipap

• it's unclear whether bipap is effective
• up to 20% of OSA pts starting on CPAP can also be found to have underlying central events in the first 3 months

ASV

• adjusts each breath pressure levels
• can increase PS during apnea and hyponea; can also decrease PS during hyperventilation

Hypoventilation Treatment

• OHS, COPD, restrictive lung disease
• these require noninvasive ventilation

OHS

• obesity, hypercapnea, SDB
• exclude other causes for hypoventilation
• CPAP recommended initial therapy
• Bipap next
• VAPS may be tried to assure tidal volume

NM weakness

• neuro stimulator

Links to this note

• Sleep and Sleep Disordered Breathing
  • Murray and Nadel Ch 122 Sleep Disordered Breathing Treatment
• Murray and Nadel Textbook of Respiratory Medicine
  • Murray and Nadel Ch 122 Sleep Disordered Breathing Treatment
• conservative management for OSA includes weight loss, devices, and sleep positioning
  • [^1]: Murray and Nadel Ch 122 Sleep Disordered Breathing Treatment
• CPAP, Bipap, and ASV are main treatment for central sleep apnea
  • [^1]: Murray and Nadel Ch 122 Sleep Disordered Breathing Treatment
• difference between OSA, OHS
  • [^1]: Murray and Nadel Ch 122 Sleep Disordered Breathing Treatment
• hypoglossal nerve stimulator
  • [^1]: Murray and Nadel Ch 122 Sleep Disordered Breathing Treatment
• nasal and mandibular surgeries as treatment options for OSA
  • [^1]: Murray and Nadel Ch 122 Sleep Disordered Breathing Treatment
• nocturnal hypoxemia has various pathophysiology
  • [^2]: Murray and Nadel Ch 122 Sleep Disordered Breathing Treatment
• nocturnal oxygen does not treat root cause of OSA
  • [^1]: Murray and Nadel Ch 122 Sleep Disordered Breathing Treatment
• OSA treatment flow diagram
  • [^1]: Murray and Nadel Ch 122 Sleep Disordered Breathing Treatment
• overview treatment of OHS
  • [^1]: Murray and Nadel Ch 122 Sleep Disordered Breathing Treatment
• phrenic nerve stimulation as treatment for central sleep apnea and hypoventilation
  • [^1]: Murray and Nadel Ch 122 Sleep Disordered Breathing Treatment