Skip to main content
Thorax logoLink to Thorax
. 2005 Jan;60(1):68–75. doi: 10.1136/thx.2003.007195

Sleep · 7: Positive airway pressure therapy for obstructive sleep apnoea/hypopnoea syndrome

P Gordon 1, M Sanders 1
PMCID: PMC1747175  PMID: 15618587

Abstract

The use of continuous positive airway pressure (CPAP) in treating symptoms associated with OSAHS is reviewed. Although it is an imperfect intervention, it continues to evolve and improve in such a way that patients who would not have been able to use this treatment even in the recent past can benefit from it today.

Full Text

The Full Text of this article is available as a PDF (160.9 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Abbey N. C., Cooper K. R., Kwentus J. A. Benefit of nasal CPAP in obstructive sleep apnea is due to positive pharyngeal pressure. Sleep. 1989 Oct;12(5):420–422. [PubMed] [Google Scholar]
  2. Alarcón A., León C., Maimó A., Barbé F., Agustí A. G., Rodríguez-Roisin R., Granados A., Montserrat J. M. Cumplimiento del tratamiento con presión positiva continua nasal (CPAP) en el síndrome de las apneas-hipopneas durante el sueño. Arch Bronconeumol. 1995 Feb;31(2):56–61. doi: 10.1016/s0300-2896(15)30964-9. [DOI] [PubMed] [Google Scholar]
  3. Alex C. G., Aronson R. M., Onal E., Lopata M. Effects of continuous positive airway pressure on upper airway and respiratory muscle activity. J Appl Physiol (1985) 1987 May;62(5):2026–2030. doi: 10.1152/jappl.1987.62.5.2026. [DOI] [PubMed] [Google Scholar]
  4. Alvarez-Sala R., Díaz S., Prados C., Villasante C., Villamor J. Increase of intraocular pressure during nasal CPAP. Chest. 1992 May;101(5):1477–1477. doi: 10.1378/chest.101.5.1477-a. [DOI] [PubMed] [Google Scholar]
  5. Ballester E., Badia J. R., Hernández L., Carrasco E., de Pablo J., Fornas C., Rodriguez-Roisin R., Montserrat J. M. Evidence of the effectiveness of continuous positive airway pressure in the treatment of sleep apnea/hypopnea syndrome. Am J Respir Crit Care Med. 1999 Feb;159(2):495–501. doi: 10.1164/ajrccm.159.2.9804061. [DOI] [PubMed] [Google Scholar]
  6. Barbé F., Mayoralas L. R., Duran J., Masa J. F., Maimó A., Montserrat J. M., Monasterio C., Bosch M., Ladaria A., Rubio M. Treatment with continuous positive airway pressure is not effective in patients with sleep apnea but no daytime sleepiness. a randomized, controlled trial. Ann Intern Med. 2001 Jun 5;134(11):1015–1023. doi: 10.7326/0003-4819-134-11-200106050-00007. [DOI] [PubMed] [Google Scholar]
  7. Barbé, Pericás J., Muñoz A., Findley L., Antó J. M., Agustí A. G. Automobile accidents in patients with sleep apnea syndrome. An epidemiological and mechanistic study. Am J Respir Crit Care Med. 1998 Jul;158(1):18–22. doi: 10.1164/ajrccm.158.1.9709135. [DOI] [PubMed] [Google Scholar]
  8. Begle R. L., Badr S., Skatrud J. B., Dempsey J. A. Effect of lung inflation on pulmonary resistance during NREM sleep. Am Rev Respir Dis. 1990 Apr;141(4 Pt 1):854–860. doi: 10.1164/ajrccm/141.4_Pt_1.854. [DOI] [PubMed] [Google Scholar]
  9. Berry Richard B., Parish James M., Hartse Kristyna M. The use of auto-titrating continuous positive airway pressure for treatment of adult obstructive sleep apnea. An American Academy of Sleep Medicine review. Sleep. 2002 Mar 15;25(2):148–173. [PubMed] [Google Scholar]
  10. Berthon-Jones M. Feasibility of a self-setting CPAP machine. Sleep. 1993 Dec;16(8 Suppl):S120–S123. doi: 10.1093/sleep/16.suppl_8.s120. [DOI] [PubMed] [Google Scholar]
  11. Bradley T. D., Brown I. G., Grossman R. F., Zamel N., Martinez D., Phillipson E. A., Hoffstein V. Pharyngeal size in snorers, nonsnorers, and patients with obstructive sleep apnea. N Engl J Med. 1986 Nov 20;315(21):1327–1331. doi: 10.1056/NEJM198611203152105. [DOI] [PubMed] [Google Scholar]
  12. Bradley T. D., Floras J. S. Pathophysiologic and therapeutic implications of sleep apnea in congestive heart failure. J Card Fail. 1996 Sep;2(3):223–240. doi: 10.1016/s1071-9164(96)80045-5. [DOI] [PubMed] [Google Scholar]
  13. Bradley T. D., Holloway R. M., McLaughlin P. R., Ross B. L., Walters J., Liu P. P. Cardiac output response to continuous positive airway pressure in congestive heart failure. Am Rev Respir Dis. 1992 Feb;145(2 Pt 1):377–382. doi: 10.1164/ajrccm/145.2_Pt_1.377. [DOI] [PubMed] [Google Scholar]
  14. Brown I. G., McClean P. A., Webster P. M., Hoffstein V., Zamel N. Lung volume dependence of esophageal pressure in the neck. J Appl Physiol (1985) 1985 Dec;59(6):1849–1854. doi: 10.1152/jappl.1985.59.6.1849. [DOI] [PubMed] [Google Scholar]
  15. Cheshire K., Engleman H., Deary I., Shapiro C., Douglas N. J. Factors impairing daytime performance in patients with sleep apnea/hypopnea syndrome. Arch Intern Med. 1992 Mar;152(3):538–541. [PubMed] [Google Scholar]
  16. Chin K., Nakamura T., Shimizu K., Mishima M., Nakamura T., Miyasaka M., Ohi M. Effects of nasal continuous positive airway pressure on soluble cell adhesion molecules in patients with obstructive sleep apnea syndrome. Am J Med. 2000 Nov;109(7):562–567. doi: 10.1016/s0002-9343(00)00580-5. [DOI] [PubMed] [Google Scholar]
  17. Chin K., Shimizu K., Nakamura T., Narai N., Masuzaki H., Ogawa Y., Mishima M., Nakamura T., Nakao K., Ohi M. Changes in intra-abdominal visceral fat and serum leptin levels in patients with obstructive sleep apnea syndrome following nasal continuous positive airway pressure therapy. Circulation. 1999 Aug 17;100(7):706–712. doi: 10.1161/01.cir.100.7.706. [DOI] [PubMed] [Google Scholar]
  18. Davies R. J., Harrington K. J., Ormerod O. J., Stradling J. R. Nasal continuous positive airway pressure in chronic heart failure with sleep-disordered breathing. Am Rev Respir Dis. 1993 Mar;147(3):630–634. doi: 10.1164/ajrccm/147.3.630. [DOI] [PubMed] [Google Scholar]
  19. Dean R. T., Wilcox I. Possible atherogenic effects of hypoxia during obstructive sleep apnea. Sleep. 1993 Dec;16(8 Suppl):S15–S22. doi: 10.1093/sleep/16.suppl_8.s15. [DOI] [PubMed] [Google Scholar]
  20. Derderian S. S., Bridenbaugh R. H., Rajagopal K. R. Neuropsychologic symptoms in obstructive sleep apnea improve after treatment with nasal continuous positive airway pressure. Chest. 1988 Nov;94(5):1023–1027. doi: 10.1378/chest.94.5.1023. [DOI] [PubMed] [Google Scholar]
  21. Dimsdale J. E., Loredo J. S., Profant J. Effect of continuous positive airway pressure on blood pressure : a placebo trial. Hypertension. 2000 Jan;35(1 Pt 1):144–147. doi: 10.1161/01.hyp.35.1.144. [DOI] [PubMed] [Google Scholar]
  22. Duchna H. W., Guilleminault C., Stoohs R. A., Faul J. L., Moreno H., Hoffman B. B., Blaschke T. F. Vascular reactivity in obstructive sleep apnea syndrome. Am J Respir Crit Care Med. 2000 Jan;161(1):187–191. doi: 10.1164/ajrccm.161.1.9810062. [DOI] [PubMed] [Google Scholar]
  23. Engleman H. M., Asgari-Jirhandeh N., McLeod A. L., Ramsay C. F., Deary I. J., Douglas N. J. Self-reported use of CPAP and benefits of CPAP therapy: a patient survey. Chest. 1996 Jun;109(6):1470–1476. doi: 10.1378/chest.109.6.1470. [DOI] [PubMed] [Google Scholar]
  24. Engleman H. M., Cheshire K. E., Deary I. J., Douglas N. J. Daytime sleepiness, cognitive performance and mood after continuous positive airway pressure for the sleep apnoea/hypopnoea syndrome. Thorax. 1993 Sep;48(9):911–914. doi: 10.1136/thx.48.9.911. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Engleman H. M., Kingshott R. N., Martin S. E., Douglas N. J. Cognitive function in the sleep apnea/hypopnea syndrome (SAHS). Sleep. 2000 Jun 15;23 (Suppl 4):S102–S108. [PubMed] [Google Scholar]
  26. Engleman H. M., Kingshott R. N., Wraith P. K., Mackay T. W., Deary I. J., Douglas N. J. Randomized placebo-controlled crossover trial of continuous positive airway pressure for mild sleep Apnea/Hypopnea syndrome. Am J Respir Crit Care Med. 1999 Feb;159(2):461–467. doi: 10.1164/ajrccm.159.2.9803121. [DOI] [PubMed] [Google Scholar]
  27. Engleman H. M., Martin S. E., Deary I. J., Douglas N. J. Effect of CPAP therapy on daytime function in patients with mild sleep apnoea/hypopnoea syndrome. Thorax. 1997 Feb;52(2):114–119. doi: 10.1136/thx.52.2.114. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Engleman H. M., Martin S. E., Deary I. J., Douglas N. J. Effect of continuous positive airway pressure treatment on daytime function in sleep apnoea/hypopnoea syndrome. Lancet. 1994 Mar 5;343(8897):572–575. doi: 10.1016/s0140-6736(94)91522-9. [DOI] [PubMed] [Google Scholar]
  29. Engleman H. M., Martin S. E., Douglas N. J. Compliance with CPAP therapy in patients with the sleep apnoea/hypopnoea syndrome. Thorax. 1994 Mar;49(3):263–266. doi: 10.1136/thx.49.3.263. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Engleman H. M., Martin S. E., Kingshott R. N., Mackay T. W., Deary I. J., Douglas N. J. Randomised placebo controlled trial of daytime function after continuous positive airway pressure (CPAP) therapy for the sleep apnoea/hypopnoea syndrome. Thorax. 1998 May;53(5):341–345. doi: 10.1136/thx.53.5.341. [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. Faccenda J. F., Mackay T. W., Boon N. A., Douglas N. J. Randomized placebo-controlled trial of continuous positive airway pressure on blood pressure in the sleep apnea-hypopnea syndrome. Am J Respir Crit Care Med. 2001 Feb;163(2):344–348. doi: 10.1164/ajrccm.163.2.2005037. [DOI] [PubMed] [Google Scholar]
  32. Farré R., Peslin R., Montserrat J. M., Rotger M., Navajas D. Flow-dependent positive airway pressure to maintain airway patency in sleep apnea-hypopnea syndrome. Am J Respir Crit Care Med. 1998 Jun;157(6 Pt 1):1855–1863. doi: 10.1164/ajrccm.157.6.9710056. [DOI] [PubMed] [Google Scholar]
  33. Faulx Michael D., Larkin Emma K., Hoit Brian D., Aylor Joan E., Wright Andrew T., Redline Susan. Sex influences endothelial function in sleep-disordered breathing. Sleep. 2004 Sep 15;27(6):1113–1120. doi: 10.1093/sleep/27.6.1113. [DOI] [PubMed] [Google Scholar]
  34. Findley L. J., Suratt P. M. Serious motor vehicle crashes: the cost of untreated sleep apnoea. Thorax. 2001 Jul;56(7):505–505. doi: 10.1136/thorax.56.7.505. [DOI] [PMC free article] [PubMed] [Google Scholar]
  35. Fletcher E. C. Effect of episodic hypoxia on sympathetic activity and blood pressure. Respir Physiol. 2000 Feb;119(2-3):189–197. doi: 10.1016/s0034-5687(99)00114-0. [DOI] [PubMed] [Google Scholar]
  36. Fletcher E. C., Luckett R. A. The effect of positive reinforcement on hourly compliance in nasal continuous positive airway pressure users with obstructive sleep apnea. Am Rev Respir Dis. 1991 May;143(5 Pt 1):936–941. doi: 10.1164/ajrccm/143.5_Pt_1.936. [DOI] [PubMed] [Google Scholar]
  37. Fleury B., Rakotonanahary D., Tehindrazanarivelo A. D., Hausser-Hauw C., Lebeau B. Long-term compliance to continuous positive airway pressure therapy (nCPAP) set up during a split-night polysomnography. Sleep. 1994 Sep;17(6):512–515. doi: 10.1093/sleep/17.6.512. [DOI] [PubMed] [Google Scholar]
  38. Garpestad E., Katayama H., Parker J. A., Ringler J., Lilly J., Yasuda T., Moore R. H., Strauss H. W., Weiss J. W. Stroke volume and cardiac output decrease at termination of obstructive apneas. J Appl Physiol (1985) 1992 Nov;73(5):1743–1748. doi: 10.1152/jappl.1992.73.5.1743. [DOI] [PubMed] [Google Scholar]
  39. George C. F. Reduction in motor vehicle collisions following treatment of sleep apnoea with nasal CPAP. Thorax. 2001 Jul;56(7):508–512. doi: 10.1136/thorax.56.7.508. [DOI] [PMC free article] [PubMed] [Google Scholar]
  40. Hack M., Davies R. J., Mullins R., Choi S. J., Ramdassingh-Dow S., Jenkinson C., Stradling J. R. Randomised prospective parallel trial of therapeutic versus subtherapeutic nasal continuous positive airway pressure on simulated steering performance in patients with obstructive sleep apnoea. Thorax. 2000 Mar;55(3):224–231. doi: 10.1136/thorax.55.3.224. [DOI] [PMC free article] [PubMed] [Google Scholar]
  41. Haynes W. G., Morgan D. A., Walsh S. A., Mark A. L., Sivitz W. I. Receptor-mediated regional sympathetic nerve activation by leptin. J Clin Invest. 1997 Jul 15;100(2):270–278. doi: 10.1172/JCI119532. [DOI] [PMC free article] [PubMed] [Google Scholar]
  42. Herrejón Silvestre A., Inchaurraga Alvarez I., Marín González M. Neumotórax espontáneo asociado al uso de BiPAP nocturno con mascarilla nasal. Arch Bronconeumol. 1998 Nov;34(10):512–512. [PubMed] [Google Scholar]
  43. Hla K. M., Young T. B., Bidwell T., Palta M., Skatrud J. B., Dempsey J. Sleep apnea and hypertension. A population-based study. Ann Intern Med. 1994 Mar 1;120(5):382–388. doi: 10.7326/0003-4819-120-5-199403010-00005. [DOI] [PubMed] [Google Scholar]
  44. Hoffstein V., Viner S., Mateika S., Conway J. Treatment of obstructive sleep apnea with nasal continuous positive airway pressure. Patient compliance, perception of benefits, and side effects. Am Rev Respir Dis. 1992 Apr;145(4 Pt 1):841–845. doi: 10.1164/ajrccm/145.4_Pt_1.841. [DOI] [PubMed] [Google Scholar]
  45. Hoffstein V., Zamel N., Phillipson E. A. Lung volume dependence of pharyngeal cross-sectional area in patients with obstructive sleep apnea. Am Rev Respir Dis. 1984 Aug;130(2):175–178. doi: 10.1164/arrd.1984.130.2.175. [DOI] [PubMed] [Google Scholar]
  46. Hoy C. J., Vennelle M., Kingshott R. N., Engleman H. M., Douglas N. J. Can intensive support improve continuous positive airway pressure use in patients with the sleep apnea/hypopnea syndrome? Am J Respir Crit Care Med. 1999 Apr;159(4 Pt 1):1096–1100. doi: 10.1164/ajrccm.159.4.9808008. [DOI] [PubMed] [Google Scholar]
  47. Hudgel D. W., Fung C. A long-term randomized, cross-over comparison of auto-titrating and standard nasal continuous airway pressure. Sleep. 2000 Aug 1;23(5):645–648. [PubMed] [Google Scholar]
  48. Hui D. S., Chan J. K., Choy D. K., Ko F. W., Li T. S., Leung R. C., Lai C. K. Effects of augmented continuous positive airway pressure education and support on compliance and outcome in a Chinese population. Chest. 2000 May;117(5):1410–1416. doi: 10.1378/chest.117.5.1410. [DOI] [PubMed] [Google Scholar]
  49. Jarjour N. N., Wilson P. Pneumocephalus associated with nasal continuous positive airway pressure in a patient with sleep apnea syndrome. Chest. 1989 Dec;96(6):1425–1426. doi: 10.1378/chest.96.6.1425. [DOI] [PubMed] [Google Scholar]
  50. Javaheri S. Central sleep apnea-hypopnea syndrome in heart failure: prevalence, impact, and treatment. Sleep. 1996 Dec;19(10 Suppl):S229–S231. [PubMed] [Google Scholar]
  51. Jenkinson C., Davies R. J., Mullins R., Stradling J. R. Comparison of therapeutic and subtherapeutic nasal continuous positive airway pressure for obstructive sleep apnoea: a randomised prospective parallel trial. Lancet. 1999 Jun 19;353(9170):2100–2105. doi: 10.1016/S0140-6736(98)10532-9. [DOI] [PubMed] [Google Scholar]
  52. Kiselak J., Clark M., Pera V., Rosenberg C., Redline S. The association between hypertension and sleep apnea in obese patients. Chest. 1993 Sep;104(3):775–780. doi: 10.1378/chest.104.3.775. [DOI] [PubMed] [Google Scholar]
  53. Konermann M., Sanner B. M., Vyleta M., Laschewski F., Groetz J., Sturm A., Zidek W. Use of conventional and self-adjusting nasal continuous positive airway pressure for treatment of severe obstructive sleep apnea syndrome: a comparative study. Chest. 1998 Mar;113(3):714–718. doi: 10.1378/chest.113.3.714. [DOI] [PubMed] [Google Scholar]
  54. Krachman S. L., D'Alonzo G. E., Berger T. J., Eisen H. J. Comparison of oxygen therapy with nasal continuous positive airway pressure on Cheyne-Stokes respiration during sleep in congestive heart failure. Chest. 1999 Dec;116(6):1550–1557. doi: 10.1378/chest.116.6.1550. [DOI] [PubMed] [Google Scholar]
  55. Kribbs N. B., Pack A. I., Kline L. R., Getsy J. E., Schuett J. S., Henry J. N., Maislin G., Dinges D. F. Effects of one night without nasal CPAP treatment on sleep and sleepiness in patients with obstructive sleep apnea. Am Rev Respir Dis. 1993 May;147(5):1162–1168. doi: 10.1164/ajrccm/147.5.1162. [DOI] [PubMed] [Google Scholar]
  56. Kribbs N. B., Pack A. I., Kline L. R., Smith P. L., Schwartz A. R., Schubert N. M., Redline S., Henry J. N., Getsy J. E., Dinges D. F. Objective measurement of patterns of nasal CPAP use by patients with obstructive sleep apnea. Am Rev Respir Dis. 1993 Apr;147(4):887–895. doi: 10.1164/ajrccm/147.4.887. [DOI] [PubMed] [Google Scholar]
  57. Krieger J., Follenius M., Sforza E., Brandenberger G., Peter J. D. Effects of treatment with nasal continuous positive airway pressure on atrial natriuretic peptide and arginine vasopressin release during sleep in patients with obstructive sleep apnoea. Clin Sci (Lond) 1991 May;80(5):443–449. doi: 10.1042/cs0800443. [DOI] [PubMed] [Google Scholar]
  58. Krieger J., Grucker D., Sforza E., Chambron J., Kurtz D. Left ventricular ejection fraction in obstructive sleep apnea. Effects of long-term treatment with nasal continuous positive airway pressure. Chest. 1991 Oct;100(4):917–921. doi: 10.1378/chest.100.4.917. [DOI] [PubMed] [Google Scholar]
  59. Lamphere J., Roehrs T., Wittig R., Zorick F., Conway W. A., Roth T. Recovery of alertness after CPAP in apnea. Chest. 1989 Dec;96(6):1364–1367. doi: 10.1378/chest.96.6.1364. [DOI] [PubMed] [Google Scholar]
  60. Lavie P., Herer P., Hoffstein V. Obstructive sleep apnoea syndrome as a risk factor for hypertension: population study. BMJ. 2000 Feb 19;320(7233):479–482. doi: 10.1136/bmj.320.7233.479. [DOI] [PMC free article] [PubMed] [Google Scholar]
  61. Littner Michael, Hirshkowitz Maxwell, Davila David, Anderson W. McDowell, Kushida Clete A., Woodson B. Tucker, Johnson Stephen F., Merrill S. Wise, Standards of Practice Committee of the American Academy of Sleep Medicine Practice parameters for the use of auto-titrating continuous positive airway pressure devices for titrating pressures and treating adult patients with obstructive sleep apnea syndrome. An American Academy of Sleep Medicine report. Sleep. 2002 Mar 15;25(2):143–147. doi: 10.1093/sleep/25.2.143. [DOI] [PubMed] [Google Scholar]
  62. Lofaso F., Lorino A. M., Duizabo D., Najafi Zadeh H., Theret D., Goldenberg F., Harf A. Evaluation of an auto-nCPAP device based on snoring detection. Eur Respir J. 1996 Sep;9(9):1795–1800. doi: 10.1183/09031936.96.09091795. [DOI] [PubMed] [Google Scholar]
  63. Loube D. I., Gay P. C., Strohl K. P., Pack A. I., White D. P., Collop N. A. Indications for positive airway pressure treatment of adult obstructive sleep apnea patients: a consensus statement. Chest. 1999 Mar;115(3):863–866. doi: 10.1378/chest.115.3.863. [DOI] [PubMed] [Google Scholar]
  64. MacMahon S., Peto R., Cutler J., Collins R., Sorlie P., Neaton J., Abbott R., Godwin J., Dyer A., Stamler J. Blood pressure, stroke, and coronary heart disease. Part 1, Prolonged differences in blood pressure: prospective observational studies corrected for the regression dilution bias. Lancet. 1990 Mar 31;335(8692):765–774. doi: 10.1016/0140-6736(90)90878-9. [DOI] [PubMed] [Google Scholar]
  65. Malone S., Liu P. P., Holloway R., Rutherford R., Xie A., Bradley T. D. Obstructive sleep apnoea in patients with dilated cardiomyopathy: effects of continuous positive airway pressure. Lancet. 1991 Dec 14;338(8781):1480–1484. doi: 10.1016/0140-6736(91)92299-h. [DOI] [PubMed] [Google Scholar]
  66. Martins De Araújo M. T., Vieira S. B., Vasquez E. C., Fleury B. Heated humidification or face mask to prevent upper airway dryness during continuous positive airway pressure therapy. Chest. 2000 Jan;117(1):142–147. doi: 10.1378/chest.117.1.142. [DOI] [PubMed] [Google Scholar]
  67. Massie C. A., Hart R. W., Peralez K., Richards G. N. Effects of humidification on nasal symptoms and compliance in sleep apnea patients using continuous positive airway pressure. Chest. 1999 Aug;116(2):403–408. doi: 10.1378/chest.116.2.403. [DOI] [PubMed] [Google Scholar]
  68. Mawhinney H., Spector S. L., Kinsman R. A., Siegel S. C., Rachelefsky G. S., Katz R. M., Rohr A. S. Compliance in clinical trials of two nonbronchodilator, antiasthma medications. Ann Allergy. 1991 Apr;66(4):294–299. [PubMed] [Google Scholar]
  69. Mayer J., Becker H., Brandenburg U., Penzel T., Peter J. H., von Wichert P. Blood pressure and sleep apnea: results of long-term nasal continuous positive airway pressure therapy. Cardiology. 1991;79(2):84–92. doi: 10.1159/000174864. [DOI] [PubMed] [Google Scholar]
  70. McArdle N., Devereux G., Heidarnejad H., Engleman H. M., Mackay T. W., Douglas N. J. Long-term use of CPAP therapy for sleep apnea/hypopnea syndrome. Am J Respir Crit Care Med. 1999 Apr;159(4 Pt 1):1108–1114. doi: 10.1164/ajrccm.159.4.9807111. [DOI] [PubMed] [Google Scholar]
  71. Meurice J. C., Dore P., Paquereau J., Neau J. P., Ingrand P., Chavagnat J. J., Patte F. Predictive factors of long-term compliance with nasal continuous positive airway pressure treatment in sleep apnea syndrome. Chest. 1994 Feb;105(2):429–433. doi: 10.1378/chest.105.2.429. [DOI] [PubMed] [Google Scholar]
  72. Meurice J. C., Marc I., Sériès F. Efficacy of auto-CPAP in the treatment of obstructive sleep apnea/hypopnea syndrome. Am J Respir Crit Care Med. 1996 Feb;153(2):794–798. doi: 10.1164/ajrccm.153.2.8564134. [DOI] [PubMed] [Google Scholar]
  73. Midelton Gary T., Frishman William H., Passo Stanley S. Congestive heart failure and continuous positive airway pressure therapy: support of a new modality for improving the prognosis and survival of patients with advanced congestive heart failure. Heart Dis. 2002 Mar-Apr;4(2):102–109. doi: 10.1097/00132580-200203000-00007. [DOI] [PubMed] [Google Scholar]
  74. Monasterio C., Vidal S., Duran J., Ferrer M., Carmona C., Barbé F., Mayos M., Gonzalez-Mangado N., Juncadella M., Navarro A. Effectiveness of continuous positive airway pressure in mild sleep apnea-hypopnea syndrome. Am J Respir Crit Care Med. 2001 Sep 15;164(6):939–943. doi: 10.1164/ajrccm.164.6.2008010. [DOI] [PubMed] [Google Scholar]
  75. Montserrat J. M., Ferrer M., Hernandez L., Farré R., Vilagut G., Navajas D., Badia J. R., Carrasco E., De Pablo J., Ballester E. Effectiveness of CPAP treatment in daytime function in sleep apnea syndrome: a randomized controlled study with an optimized placebo. Am J Respir Crit Care Med. 2001 Aug 15;164(4):608–613. doi: 10.1164/ajrccm.164.4.2006034. [DOI] [PubMed] [Google Scholar]
  76. Mortimore I. L., Whittle A. T., Douglas N. J. Comparison of nose and face mask CPAP therapy for sleep apnoea. Thorax. 1998 Apr;53(4):290–292. doi: 10.1136/thx.53.4.290. [DOI] [PMC free article] [PubMed] [Google Scholar]
  77. Muñoz A., Mayoralas L. R., Barbé F., Pericás J., Agusti A. G. Long-term effects of CPAP on daytime functioning in patients with sleep apnoea syndrome. Eur Respir J. 2000 Apr;15(4):676–681. doi: 10.1034/j.1399-3003.2000.15d09.x. [DOI] [PubMed] [Google Scholar]
  78. Narkiewicz K., Kato M., Phillips B. G., Pesek C. A., Davison D. E., Somers V. K. Nocturnal continuous positive airway pressure decreases daytime sympathetic traffic in obstructive sleep apnea. Circulation. 1999 Dec 7;100(23):2332–2335. doi: 10.1161/01.cir.100.23.2332. [DOI] [PubMed] [Google Scholar]
  79. Narkiewicz K., van de Borne P. J., Montano N., Dyken M. E., Phillips B. G., Somers V. K. Contribution of tonic chemoreflex activation to sympathetic activity and blood pressure in patients with obstructive sleep apnea. Circulation. 1998 Mar 17;97(10):943–945. doi: 10.1161/01.cir.97.10.943. [DOI] [PubMed] [Google Scholar]
  80. Naughton M. T., Bradley T. D. Sleep apnea in congestive heart failure. Clin Chest Med. 1998 Mar;19(1):99–113. doi: 10.1016/s0272-5231(05)70435-4. [DOI] [PubMed] [Google Scholar]
  81. Naëgelé B., Thouvard V., Pépin J. L., Lévy P., Bonnet C., Perret J. E., Pellat J., Feuerstein C. Deficits of cognitive executive functions in patients with sleep apnea syndrome. Sleep. 1995 Jan;18(1):43–52. [PubMed] [Google Scholar]
  82. Nelesen R. A., Yu H., Ziegler M. G., Mills P. J., Clausen J. L., Dimsdale J. E. Continuous positive airway pressure normalizes cardiac autonomic and hemodynamic responses to a laboratory stressor in apneic patients. Chest. 2001 Apr;119(4):1092–1101. doi: 10.1378/chest.119.4.1092. [DOI] [PubMed] [Google Scholar]
  83. Newman A. B., Nieto F. J., Guidry U., Lind B. K., Redline S., Pickering T. G., Quan S. F., Sleep Heart Health Study Research Group Relation of sleep-disordered breathing to cardiovascular disease risk factors: the Sleep Heart Health Study. Am J Epidemiol. 2001 Jul 1;154(1):50–59. doi: 10.1093/aje/154.1.50. [DOI] [PubMed] [Google Scholar]
  84. Nieto F. J., Young T. B., Lind B. K., Shahar E., Samet J. M., Redline S., D'Agostino R. B., Newman A. B., Lebowitz M. D., Pickering T. G. Association of sleep-disordered breathing, sleep apnea, and hypertension in a large community-based study. Sleep Heart Health Study. JAMA. 2000 Apr 12;283(14):1829–1836. doi: 10.1001/jama.283.14.1829. [DOI] [PubMed] [Google Scholar]
  85. Nieto F. J., Young T. B., Lind B. K., Shahar E., Samet J. M., Redline S., D'Agostino R. B., Newman A. B., Lebowitz M. D., Pickering T. G. Association of sleep-disordered breathing, sleep apnea, and hypertension in a large community-based study. Sleep Heart Health Study. JAMA. 2000 Apr 12;283(14):1829–1836. doi: 10.1001/jama.283.14.1829. [DOI] [PubMed] [Google Scholar]
  86. Nino-Murcia G., McCann C. C., Bliwise D. L., Guilleminault C., Dement W. C. Compliance and side effects in sleep apnea patients treated with nasal continuous positive airway pressure. West J Med. 1989 Feb;150(2):165–169. [PMC free article] [PubMed] [Google Scholar]
  87. Nonogaki K. Obesity: autonomic circuits versus feeding. Nat Med. 1999 Jul;5(7):742–743. doi: 10.1038/10464. [DOI] [PubMed] [Google Scholar]
  88. Peppard P. E., Young T., Palta M., Skatrud J. Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med. 2000 May 11;342(19):1378–1384. doi: 10.1056/NEJM200005113421901. [DOI] [PubMed] [Google Scholar]
  89. Pepperell Justin C. T., Ramdassingh-Dow Sharon, Crosthwaite Nicky, Mullins Rebecca, Jenkinson Crispin, Stradling John R., Davies Robert J. O. Ambulatory blood pressure after therapeutic and subtherapeutic nasal continuous positive airway pressure for obstructive sleep apnoea: a randomised parallel trial. Lancet. 2002 Jan 19;359(9302):204–210. doi: 10.1016/S0140-6736(02)07445-7. [DOI] [PubMed] [Google Scholar]
  90. Phillips B. G., Kato M., Narkiewicz K., Choe I., Somers V. K. Increases in leptin levels, sympathetic drive, and weight gain in obstructive sleep apnea. Am J Physiol Heart Circ Physiol. 2000 Jul;279(1):H234–H237. doi: 10.1152/ajpheart.2000.279.1.H234. [DOI] [PubMed] [Google Scholar]
  91. Phillips B. G., Somers V. K. Neural and humoral mechanisms mediating cardiovascular responses to obstructive sleep apnea. Respir Physiol. 2000 Feb;119(2-3):181–187. doi: 10.1016/s0034-5687(99)00113-9. [DOI] [PubMed] [Google Scholar]
  92. Pressman M. R., Peterson D. D., Meyer T. J., Harkins J. P., Gurijala L. Ramp abuse. A novel form of patient noncompliance to administration of nasal continuous positive airway pressure for treatment of obstructive sleep apnea. Am J Respir Crit Care Med. 1995 May;151(5):1632–1634. doi: 10.1164/ajrccm.151.5.7735625. [DOI] [PubMed] [Google Scholar]
  93. Prosise G. L., Berry R. B. Oral-nasal continuous positive airway pressure as a treatment for obstructive sleep apnea. Chest. 1994 Jul;106(1):180–186. doi: 10.1378/chest.106.1.180. [DOI] [PubMed] [Google Scholar]
  94. Pépin J. L., Leger P., Veale D., Langevin B., Robert D., Lévy P. Side effects of nasal continuous positive airway pressure in sleep apnea syndrome. Study of 193 patients in two French sleep centers. Chest. 1995 Feb;107(2):375–381. doi: 10.1378/chest.107.2.375. [DOI] [PubMed] [Google Scholar]
  95. Rakotonanahary D., Pelletier-Fleury N., Gagnadoux F., Fleury B. Predictive factors for the need for additional humidification during nasal continuous positive airway pressure therapy. Chest. 2001 Feb;119(2):460–465. doi: 10.1378/chest.119.2.460. [DOI] [PubMed] [Google Scholar]
  96. Randerath W. J., Parys K., Feldmeyer F., Sanner B., Rühle K. H. Self-adjusting nasal continuous positive airway pressure therapy based on measurement of impedance: A comparison of two different maximum pressure levels. Chest. 1999 Oct;116(4):991–999. doi: 10.1378/chest.116.4.991. [DOI] [PubMed] [Google Scholar]
  97. Rapoport D. M., Garay S. M., Goldring R. M. Nasal CPAP in obstructive sleep apnea: mechanisms of action. Bull Eur Physiopathol Respir. 1983 Nov-Dec;19(6):616–620. [PubMed] [Google Scholar]
  98. Rauscher H., Popp W., Wanke T., Zwick H. Acceptance of CPAP therapy for sleep apnea. Chest. 1991 Oct;100(4):1019–1023. doi: 10.1378/chest.100.4.1019. [DOI] [PubMed] [Google Scholar]
  99. Reeves-Hoche M. K., Meck R., Zwillich C. W. Nasal CPAP: an objective evaluation of patient compliance. Am J Respir Crit Care Med. 1994 Jan;149(1):149–154. doi: 10.1164/ajrccm.149.1.8111574. [DOI] [PubMed] [Google Scholar]
  100. Reeves-Hoché M. K., Hudgel D. W., Meck R., Witteman R., Ross A., Zwillich C. W. Continuous versus bilevel positive airway pressure for obstructive sleep apnea. Am J Respir Crit Care Med. 1995 Feb;151(2 Pt 1):443–449. doi: 10.1164/ajrccm.151.2.7842204. [DOI] [PubMed] [Google Scholar]
  101. Resta O., Guido P., Picca V., Sabato R., Rizzi M., Scarpelli F., Sergi M. Prescription of nCPAP and nBIPAP in obstructive sleep apnoea syndrome: Italian experience in 105 subjects. A prospective two centre study. Respir Med. 1998 Jun;92(6):820–827. doi: 10.1016/s0954-6111(98)90383-3. [DOI] [PubMed] [Google Scholar]
  102. Richards G. N., Cistulli P. A., Ungar R. G., Berthon-Jones M., Sullivan C. E. Mouth leak with nasal continuous positive airway pressure increases nasal airway resistance. Am J Respir Crit Care Med. 1996 Jul;154(1):182–186. doi: 10.1164/ajrccm.154.1.8680678. [DOI] [PubMed] [Google Scholar]
  103. Sanders M. H., Kern N. B., Stiller R. A., Strollo P. J., Jr, Martin T. J., Atwood C. W., Jr CPAP therapy via oronasal mask for obstructive sleep apnea. Chest. 1994 Sep;106(3):774–779. doi: 10.1378/chest.106.3.774. [DOI] [PubMed] [Google Scholar]
  104. Sanders M. H., Kern N. Obstructive sleep apnea treated by independently adjusted inspiratory and expiratory positive airway pressures via nasal mask. Physiologic and clinical implications. Chest. 1990 Aug;98(2):317–324. doi: 10.1378/chest.98.2.317. [DOI] [PubMed] [Google Scholar]
  105. Sanders M. H., Moore S. E. Inspiratory and expiratory partitioning of airway resistance during sleep in patients with sleep apnea. Am Rev Respir Dis. 1983 May;127(5):554–558. doi: 10.1164/arrd.1983.127.5.554. [DOI] [PubMed] [Google Scholar]
  106. Sanders M. H., Rogers R. M., Pennock B. E. Prolonged expiratory phase in sleep apnea. A unifying hypothesis. Am Rev Respir Dis. 1985 Mar;131(3):401–408. doi: 10.1164/arrd.1985.131.3.401. [DOI] [PubMed] [Google Scholar]
  107. Schäfer H., Ewig S., Hasper E., Lüderitz B. Failure of CPAP therapy in obstructive sleep apnoea syndrome: predictive factors and treatment with bilevel-positive airway pressure. Respir Med. 1998 Feb;92(2):208–215. doi: 10.1016/s0954-6111(98)90097-x. [DOI] [PubMed] [Google Scholar]
  108. Sin D. D., Logan A. G., Fitzgerald F. S., Liu P. P., Bradley T. D. Effects of continuous positive airway pressure on cardiovascular outcomes in heart failure patients with and without Cheyne-Stokes respiration. Circulation. 2000 Jul 4;102(1):61–66. doi: 10.1161/01.cir.102.1.61. [DOI] [PubMed] [Google Scholar]
  109. Somers V. K., Dyken M. E., Clary M. P., Abboud F. M. Sympathetic neural mechanisms in obstructive sleep apnea. J Clin Invest. 1995 Oct;96(4):1897–1904. doi: 10.1172/JCI118235. [DOI] [PMC free article] [PubMed] [Google Scholar]
  110. Stradling J. R., Davies R. J. Is more NCPAP better? Sleep. 2000 Jun 15;23 (Suppl 4):S150–S153. [PubMed] [Google Scholar]
  111. Strohl K. P., Redline S. Nasal CPAP therapy, upper airway muscle activation, and obstructive sleep apnea. Am Rev Respir Dis. 1986 Sep;134(3):555–558. doi: 10.1164/arrd.1986.134.3.555. [DOI] [PubMed] [Google Scholar]
  112. Strollo P. J., Jr, Sanders M. H., Costantino J. P., Walsh S. K., Stiller R. A., Atwood C. W., Jr Split-night studies for the diagnosis and treatment of sleep-disordered breathing. Sleep. 1996 Dec;19(10 Suppl):S255–S259. doi: 10.1093/sleep/19.suppl_10.s255. [DOI] [PubMed] [Google Scholar]
  113. Sullivan C. E., Issa F. G., Berthon-Jones M., Eves L. Reversal of obstructive sleep apnoea by continuous positive airway pressure applied through the nares. Lancet. 1981 Apr 18;1(8225):862–865. doi: 10.1016/s0140-6736(81)92140-1. [DOI] [PubMed] [Google Scholar]
  114. Suzuki M., Otsuka K., Guilleminault C. Long-term nasal continuous positive airway pressure administration can normalize hypertension in obstructive sleep apnea patients. Sleep. 1993 Sep;16(6):545–549. doi: 10.1093/sleep/16.6.545. [DOI] [PubMed] [Google Scholar]
  115. Sériès F., Cormier Y., Couture J., Desmeules M. Changes in upper airway resistance with lung inflation and positive airway pressure. J Appl Physiol (1985) 1990 Mar;68(3):1075–1079. doi: 10.1152/jappl.1990.68.3.1075. [DOI] [PubMed] [Google Scholar]
  116. Sériès F., Cormier Y., Desmeules M. Influence of passive changes of lung volume on upper airways. J Appl Physiol (1985) 1990 May;68(5):2159–2164. doi: 10.1152/jappl.1990.68.5.2159. [DOI] [PubMed] [Google Scholar]
  117. Tashkin D. P., Rand C., Nides M., Simmons M., Wise R., Coulson A. H., Li V., Gong H., Jr A nebulizer chronolog to monitor compliance with inhaler use. Am J Med. 1991 Oct 21;91(4A):33S–36S. doi: 10.1016/0002-9343(91)90260-5. [DOI] [PubMed] [Google Scholar]
  118. Terán-Santos J., Jiménez-Gómez A., Cordero-Guevara J. The association between sleep apnea and the risk of traffic accidents. Cooperative Group Burgos-Santander. N Engl J Med. 1999 Mar 18;340(11):847–851. doi: 10.1056/NEJM199903183401104. [DOI] [PubMed] [Google Scholar]
  119. Teschler H., Berthon-Jones M., Thompson A. B., Henkel A., Henry J., Konietzko N. Automated continuous positive airway pressure titration for obstructive sleep apnea syndrome. Am J Respir Crit Care Med. 1996 Sep;154(3 Pt 1):734–740. doi: 10.1164/ajrccm.154.3.8810613. [DOI] [PubMed] [Google Scholar]
  120. Teschler H., Farhat A. A., Exner V., Konietzko N., Berthon-Jones M. AutoSet nasal CPAP titration: constancy of pressure, compliance and effectiveness at 8 month follow-up. Eur Respir J. 1997 Sep;10(9):2073–2078. doi: 10.1183/09031936.97.10092073. [DOI] [PubMed] [Google Scholar]
  121. Teschler H., Wessendorf T. E., Farhat A. A., Konietzko N., Berthon-Jones M. Two months auto-adjusting versus conventional nCPAP for obstructive sleep apnoea syndrome. Eur Respir J. 2000 Jun;15(6):990–995. doi: 10.1034/j.1399-3003.2000.01503.x. [DOI] [PubMed] [Google Scholar]
  122. Tuck Stephanie A., Remmers John E. Mechanical properties of the passive pharynx in Vietnamese pot-bellied pigs. I. Statics. J Appl Physiol (1985) 2002 Jun;92(6):2229–2235. doi: 10.1152/japplphysiol.00761.2001. [DOI] [PubMed] [Google Scholar]
  123. Tuck Stephanie A., Remmers John E. Mechanical properties of the passive pharynx in Vietnamese pot-bellied pigs. II. Dynamics. J Appl Physiol (1985) 2002 Jun;92(6):2236–2244. doi: 10.1152/japplphysiol.00762.2001. [DOI] [PubMed] [Google Scholar]
  124. Van de Graaff W. B. Thoracic influence on upper airway patency. J Appl Physiol (1985) 1988 Nov;65(5):2124–2131. doi: 10.1152/jappl.1988.65.5.2124. [DOI] [PubMed] [Google Scholar]
  125. Van de Graaff W. B. Thoracic traction on the trachea: mechanisms and magnitude. J Appl Physiol (1985) 1991 Mar;70(3):1328–1336. doi: 10.1152/jappl.1991.70.3.1328. [DOI] [PubMed] [Google Scholar]
  126. Waldhorn R. E., Herrick T. W., Nguyen M. C., O'Donnell A. E., Sodero J., Potolicchio S. J. Long-term compliance with nasal continuous positive airway pressure therapy of obstructive sleep apnea. Chest. 1990 Jan;97(1):33–38. doi: 10.1378/chest.97.1.33. [DOI] [PubMed] [Google Scholar]
  127. Waradekar N. V., Sinoway L. I., Zwillich C. W., Leuenberger U. A. Influence of treatment on muscle sympathetic nerve activity in sleep apnea. Am J Respir Crit Care Med. 1996 Apr;153(4 Pt 1):1333–1338. doi: 10.1164/ajrccm.153.4.8616563. [DOI] [PubMed] [Google Scholar]
  128. Weaver T. E., Kribbs N. B., Pack A. I., Kline L. R., Chugh D. K., Maislin G., Smith P. L., Schwartz A. R., Schubert N. M., Gillen K. A. Night-to-night variability in CPAP use over the first three months of treatment. Sleep. 1997 Apr;20(4):278–283. doi: 10.1093/sleep/20.4.278. [DOI] [PubMed] [Google Scholar]
  129. Wiest G. H., Lehnert G., Brûck W. M., Meyer M., Hahn E. G., Ficker J. H. A heated humidifier reduces upper airway dryness during continuous positive airway pressure therapy. Respir Med. 1999 Jan;93(1):21–26. doi: 10.1016/s0954-6111(99)90072-0. [DOI] [PubMed] [Google Scholar]
  130. Wilcox I., Grunstein R. R., Hedner J. A., Doyle J., Collins F. L., Fletcher P. J., Kelly D. T., Sullivan C. E. Effect of nasal continuous positive airway pressure during sleep on 24-hour blood pressure in obstructive sleep apnea. Sleep. 1993 Sep;16(6):539–544. doi: 10.1093/sleep/16.6.539. [DOI] [PubMed] [Google Scholar]
  131. Winck João C., Delgado J. Luís, Almeida João M., Marques José A. Heated humidification during nasal continuous positive airway pressure for obstructive sleep apnea syndrome: objective evaluation of efficacy with nasal peak inspiratory flow measurements. Am J Rhinol. 2002 May-Jun;16(3):175–177. [PubMed] [Google Scholar]
  132. Young T., Blustein J., Finn L., Palta M. Sleep-disordered breathing and motor vehicle accidents in a population-based sample of employed adults. Sleep. 1997 Aug;20(8):608–613. doi: 10.1093/sleep/20.8.608. [DOI] [PubMed] [Google Scholar]
  133. Young T., Palta M., Dempsey J., Skatrud J., Weber S., Badr S. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med. 1993 Apr 29;328(17):1230–1235. doi: 10.1056/NEJM199304293281704. [DOI] [PubMed] [Google Scholar]
  134. Young T., Peppard P., Palta M., Hla K. M., Finn L., Morgan B., Skatrud J. Population-based study of sleep-disordered breathing as a risk factor for hypertension. Arch Intern Med. 1997 Aug 11;157(15):1746–1752. [PubMed] [Google Scholar]
  135. Young T., Peppard P. Sleep-disordered breathing and cardiovascular disease: epidemiologic evidence for a relationship. Sleep. 2000 Jun 15;23 (Suppl 4):S122–S126. [PubMed] [Google Scholar]

Articles from Thorax are provided here courtesy of BMJ Publishing Group

RESOURCES