Sleep-disordered breathing and positive airway pressure
Untreated OSA has been linked with a number of cardiovascular complications, including hypertension, coronary artery disease, congestive heart failure, cardiac arrhythmias, stroke, and even death.1 In addition to cardiovascular morbidity and mortality, untreated OSA is associated with multiple other negative effects, including excessive daytime sleepiness, reduced cognitive function (e.g. alertness, motor function, recall ability) and poor quality of life.2
CPAP was first described by Professor Colin Sullivan in 1981. Professor Sullivan treated five severe OSA patients with CPAP applied to the nares via tubing and a mask. The CPAP acts as a pneumatic splint which prevents the airway collapsing during sleep. It is considered a safe, non-invasive, highly effective treatment for OSA.3
Continuous positive airway pressure (CPAP) is now widely used and known as the gold standard treatment for OSA. It has been shown to reduce the risk of cardiovascular fatal and non-fatal events and decrease mortality rates compared with untreated OSA4-6. In adherent patients, CPAP therapy has also been shown to significantly improve the symptoms associated with OSA, such as excessive daytime sleepiness, cognitive function and reduced quality of life. 7,8
Shahar E, Whitney CW, Redline S, et al. Sleep-disordered breathing and cardiovascular disease: cross-sectional results of the Sleep Heart Health Study. American journal of respiratory and critical care medicine 2001;163:19-25.
Engleman HM, Douglas NJ. Sleep. 4: Sleepiness, cognitive function, and quality of life in obstructive sleep apnoea/hypopnoea syndrome. Thorax 2004;59:618-22.
Sullivan CE, Issa FG, Berthon-Jones M, Eves L. Reversal of obstructive sleep apnoea by continuous positive airway pressure applied through the nares. Lancet 1981;1:862-5.
Buchner NJ, Sanner BM, Borgel J, Rump LC (2007) Continuous positive airway pressure treatment of mild to moderate obstructive sleep apnea reduces cardiovascular risk. Am J Respir Crit Care Med 176(12):1274–1280.
Campos-Rodriguez F, Pena-Grinan N, Reyes-Nunez N, De la Cruz-Moron I, Perez-Ronchel J, De la Vega-Gallardo F, Fernandez-Palacin A (2005) Mortality in obstructive sleep ap- nea–hypopnea patients treated with positive airway pressure. Chest 128(2):624–633.
Marin JM, Carrizo SJ, Vicente E, Agusti AG (2005) Long- term cardiovascular outcomes in men with obstructive sleep apnoea–hypopnoea with or without treatment with continuous pos- itive airway pressure: an observational study. Lancet 365 (9464):1046–1053.
Avlonitou E, Kapsimalis F, Varouchakis G, Vardavas CI, Behrakis P (2011) Adherence to CPAP therapy improves quality of life and reduces symptoms among obstructive sleep apnea syndrome patients. Sleep Breath.
Giles TL, Lasserson TJ, Smith BH, White J, Wright J, Cates CJ. Continuous positive airways pressure for obstructive sleep apnoea in adults. The Cochrane database of systematic reviews 2006:Cd001106.