What are the positive effects 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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Most patients feel better during the daytime on the first day after beginning n-CPAP. During the first week of treatment, most experience rebound sleep with prolonged episodes of REM sleep. Sleep patterns become more normal after the first week. For these reasons, several weeks of n-CPAP use may be helpful for normalization of sleep patterns in patients with severe sleep apnea who plan to undergo surgery. Sleep patterns should be normalized before the planned surgical procedure.

Regular use of n-CPAP improves the quality of life for both patients and their bed partners. [82, 83, 84]  The treatment lessens depressive symptoms, and improves daytime functioning, blood pressure and insulin sensitivity. In patients with OSA who receive antihypertensive treatment, long-term CPAP was found to be responsible for a significant reduction of diastolic blood pressure. Asthmatic OSA patients have fewer nighttime symptoms. [85, 75, 86]

Other effects of using CPAP include increased vagal tone, increased cardiac output, increased stroke volume, decreased systemic vascular resistance, and reduced risk of cardiovascular mortality. [12]

Patients with OSA often have increased arterial stiffness and sympathovagal imbalance. CPAP therapy is reported to have beneficial effects on the vascular function in such patients: improvement of the sympathovagal balance by CPAP therapy may be significantly related to decreased stiffness of the central to middle-sized arteries, independent of the changes in the blood pressure and vascular endothelial status. [87]

Repetitive obstructive apnea produces acute impairment of left ventricular longitudinal function, suggesting the development of subendocardial ischemia. CPAP therapy not only decreases the severity of OSA but also ameliorates sleep-induced longitudinal left ventricular dysfunction.

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