CPAP or APAP--what is the real question?

摘要

Since Gastaut et al. first described the pathogenic mechanism of periodic airway obstruction as the root of obstructive sleep apnea (OSA) in 1965, great progress has been made in this rapidly evolving field. This progress, however, was slow in its initial development. It took another 7 years for Lugaresi's conference on Hypersomnia and Periodic Breathing in Europe to stimulate research in this area. The only treatment option for OSA at the time was tracheostomy [2, 3]. It was only as recently as 1981, when Sullivan et al. initially described nasal continuous positive airway pressure (CPAP) as a therapeutic option for the treatment of OSA. This landmark publication served as a catalyst which stirred further research in this field. At the same time, the first reports of surgical correction of OSA with uvulopalatopharyngo-plasty were emerging . Subsequent studies delineating the epidemiology of OSA [6-8] shed light onto this largely unnoticed medical condition with profound health effects. Finally, it was only in 1999 when CPAP was definitively shown to be efficacious in severe sleep apnea . It is also noted that untreated OSA has far-reaching implications in terms of increased cardiovascular risk and mortality in untreated patients. Despite relatively simple therapy, i.e. noninvasive CPAP, compliance continues to be an ongoing battle as with other chronic disease states such as obesity, diabetes, hypertension, hyperlipidemia and congestive heart failure. While considerably more re- search has been done with CPAP in the treatment of OSA and other related disease conditions (e.g. hypertension), auto-continuous positive airway pressure (APAP) is a relatively new player in the field. It has been touted as the next greatest thing in the limited arsenal of OSA treatment. The unanswered question is, however, whether it should be moved to the top of the list of options for OSA treatment.