What is the role of nasal CPAP (n-CPAP) in the treatment of sleep-disordered breathing (SDB)?

Updated: Feb 13, 2020
  • Author: Vittorio Rinaldi, MD; Chief Editor: Zab Mosenifar, MD, FACP, FCCP  more...
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Answer

When none of the above therapies are appropriate or helpful, nasal CPAP (n-CPAP) is the most effective method of managing OSAS. [66, 67, 68, 4, 69, 70, 71, 72, 73, 74, 75, 76, 77, 78, 61, 79]  n-CPAP provides a pneumatic stent for the upper airway, eliminating the airway collapse during inspiration. It is administered via a soft mask that covers the nose only. Sufficient pressure is introduced to eliminate apneas, hypopneas, and snoring. (See the image below.)

CPAP machine. CPAP machine.

Most physicians agree that patients with an RDI higher than 20 require treatment. n-CPAP can also be useful for patients with a lower RDI, especially if they experience daytime sleepiness or other symptoms. If the severity of the daytime symptoms and the Epworth Sleepiness Scale score are much greater than would be expected with a particular RDI, a trial of n-CPAP can help determine whether elimination of the SDB leads to improvement of the daytime symptoms or if other factors contribute to the daytime symptoms.

Patients who are unlikely to benefit from n-CPAP include those with such severe nasal obstruction that n-CPAP cannot be used, patients with such extreme claustrophobia that they cannot tolerate a nasal mask, and patients in whom n-CPAP does not reliably eliminate apneas, hypopneas, and snoring.


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