What are the options for autotitrating positive airway pressure during the treatment sleep-disordered breathing (SDB)?

Updated: Feb 13, 2020
  • Author: Vittorio Rinaldi, MD; Chief Editor: Zab Mosenifar, MD, FACP, FCCP  more...
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Variations of air pressure delivery can sometimes make n-CPAP use more comfortable for patients.

Autotitrating positive airway pressure (APAP) continually adjusts the pressure to a level that barely overcomes the collapsing forces. Bilevel positive airway pressure (BiPAP) provides higher pressure during inspiration (when the pneumatic splint is needed to prevent obstructive airway collapse) and lower pressure during expiration. C-Flex is another autoadjusting delivery method that increases pressure toward the end of expirations, as collapse would usually begin, and decreases pressure during early expiration.

Patients who require higher pressures to overcome obstructive apneas may tolerate these devices better than they do the one-level n-CPAP device, which delivers the higher pressure throughout the entire respiratory cycle.

Following treatment with CPAP, some patients with OSA remain sleepy despite effective CPAP, and attention should be paid to other diagnoses that can be associated to sleepiness. So-called post-CPAP sleepiness, as a specific disorder, may not exist.

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