This prevalence of 18 million people with OSA is on par with Diabetes and Asthma. It is estimated that 50% of the people that have diabetes, don’t know it. …
The Ultimate Guide to Sleep Apnea CPAP Therapy
Author:
Mark Seager, RCP CRT, BSCIS
Brought to you by
wwwYouNeedSleepcom
951-990-6321
Table of Contents:
Chapter 1: The Importance of Effective Treatment of Obstructive Sleep
Apnea 4
Welcome 4
Introduction 4
Hypertension 5
Heart Failure 5
Other Risk Factors in Untreated Sleep Apnea 5
Increase Accident Rates 5
Diabetes 6
The Cost of Untreated OSA 6
Chapter 2: What is OSA Obstructive Sleep Apnea? 7
Introduction 7
Definition of OSA 7
Causes of OSA 7
Symptoms of OSA 8
Obesity and OSA 9
Other Signs 9
Prevalence 9
Pediatric OSA 10
Chapter 3: Diagnosis of OSA 11
Definition of AHI 11
OSA Severity Defined 11
Measurement Technologies 12
PSG Advantages 12
PSG Disadvantages 12
Ambulatory Advantages 13
Ambulatory Disadvantages 14
Chapter 4: Treatment 15
Introduction 15
Treatment Options 15
CPAP 16
Auto CPAP 17
CPAP Compliance
17
CPAP BIPAP Machine Overview 19
References: 23
Chapter 1: The Importance of Effective Treatment of Obstructive Sleep
Apnea
Welcome
Welcome to this discussion on Obstructive Sleep Apnea, or OSA brought to
you by Express CPAP Supply http://wwwyouneedsleepcom
We will begin this discussion by focusing on why the effective treatment
of sleep apnea is so important, as well as some of the consequences of the
disease, such as hypertension and increased accident rates We will also
look at the basic question, What is sleep apnea? In answering this
question we will look at the pathology and specific causes of this disease
In the next section of this discussion we will look at the diagnosis of
sleep apnea We will examine the symptoms of Obstructive Sleep Apnea; we
will then look at the 2 most common measurement techniques and touch upon
their respective advantages and drawbacks We will then look at the
different treatment options available to the individual with the disease,
and look at the effectiveness of each of the available options for
treatment In closing we will provide you with an overview of the various
CPAP and BIPAP
machines currently on the market
Introduction
What is obstructive sleep apnea, and why should we care about this disease?
Why is it important? What are the symptoms? How is it diagnosed? What are
the treatment options? In my 18 years as a Respiratory Therapist, these
have been the most frequently asked questions about the disease
Why should we care about obstructive sleep apnea? Is it a disease-of-the-
week? - A nuisance disease without serious consequence? There are many
reasons sleep apnea is, and should be taken very seriously
Hypertension
Hypertension is a serious side effect of sleep apnea, independent of
obesity The throats of the sleep apnea suffer collapses throughout the
night Each event of this occurrence ends with an arousal of near
awakeness Each episode like this represents a spike in blood pressure It
has been clinically proven that there is a direct relationship between
daytime high blood pressure and obstructive sleep apnea It has also been
proven that effective treatment of sleep apnea can yield a 10 mm drop in
systolic blood pressure; making it as effective as drug therapy in the
hypertensive sleep apnea patient
Heart Failure
Heart Failure is also
related to obstructive sleep apnea, independent of
traditional risk factors A full 40 of Congestive Heart Failure CHF
patients have been found to have obstructive sleep apnea If left
untreated, sleep apnea increases the risk of heart complications by 5 fold
RDI, a measure of sleep apnea severity, which we will define shortly, is an
independent predictor of death, in coronary artery disease During a sleep
apnea event, not only is there a drop in oxygen levels, and an increase in
blood pressure, it also releases a number of inflammatory agents; these
agents are considered to greatly increase the risk of cardiovascular
disease Left Ventricular Hypertrophy also seen in patients with
Obstructive Sleep Apnea improves with treatment of OSA
Other Risk Factors in Untreated Sleep Apnea
Increase Accident Rates
Increase Accident Rates are independent of general daytime sleepiness This
means the untreated obstructive sleep apnea patient is 6 - 7 times more
likely to be in an automobile accident, even if they do not feel drowsy
during the day New Jersey has just signed the first Drowsy Driver Law
recognizing the seriousness of driving without getting an adequate amount
of sleep In some
countries, drivers diagnosed with sleep apnea risk losing
their job if they are not compliant is getting treatment for Obstructive
Sleep Apnea
Diabetes
The link between obstructive sleep apnea and diabetes is getting stronger
There is growing empirical evidence that sleep apnea starts a chain of
events that leads to diabetes Recent research has identified all the links
in this chain, and every week new studies are solidifying this
relationship There is preliminary evidence that suggests diabetes can lead
to obstructive sleep apnea If both of these finds are verified, the
potential for a downward spiral is significant
The Cost of Untreated OSA
If none of the previously mentioned reasons gives you motivation to treat
your sleep apnea, perhaps this reason will inspire a closer look at
addressing the disease - money A patient with untreated sleep apnea costs
the health care system twice as much as a control patient patient without
sleep apnea Follow up studies on the treated sleep apnea patient shows
that the per-patient costs do come down in the year following treatment,
and after 2 years, are no higher than control patients A study done in
Manitoba looked at the cost of
patients 10 years preceding diagnosis,
overall costs were double, and overnight hospital stays were also doubled
over the entire 10-year span Once again, costs came down after treatment
These results have been replicated by different studies using different
measurements of health care costs On a personal level, I have seen this
manifest itself in the clinical environment Once a patient is effectively
treated for OSA, their inpatient hospital stays for their various [other]
disease processes, simply put - decreases
In summary, there are many reasons to care about OSA Hypertension, stroke,
and cardiovascular disease are all complications of OSA The link to
diabetes continues to grow stronger as well Untreated sleep apnea patients
are 6 times more likely to get into a car accident, and the finally, in
todays environment of skyrocketing healthcare costs, an untreated sleep
apnea patient, costs the health care system twice as much as someone
without sleep apnea
Chapter 2: What is OSA Obstructive Sleep Apnea?
Introduction
Now that we know why Obstructive Sleep Apnea is important, just what is it?
Definition of OSA
Obstructive Sleep Apnea is the partial or
total closure of the upper
airway, resulting in reduction, or cessation of airflow despite persistent
respiratory effort The location of airway collapse varies from patient to
patient It may be due to a soft palette, enlarged tonsils, or the base of
the tongue falling back into the throat Please note that OSA requires
breathing effort - the throat collapses during the attempted inhalation
phase, and the patient continues trying to breathe, despite the
obstruction
Another type of apnea event is Central Apnea This happens when the patient
stops trying to breathe Central Apneas may be present in Obstructive
Sleep Apnea, but they are not the primary events A patient with
predominantly Central events does NOT have sleep apnea, and other
treatments would be indicated Far fewer patients have Primary Central
Apnea than Obstructive Sleep Apnea
Causes of OSA
What causes Obstructive Sleep Apnea? The truth is, nobody knows When we
sleep, the brain turns down most of the motor functions, except the heart
and lungs; this essentially keeps us from acting out our dreams During
sleep, the muscles of the upper airway also lose tone When this happens,
the negative pressure of an inhalation may
be, in some, enough to collapse
the airway Fatty deposits, facial structure, or other factors may result
in someone having a narrower than normal airway It is believed that this
narrowing, combined with an inherit predisposition to the disease, leads to
Obstructive Sleep Apnea
Each obstruction typically ends with an EEG Arousal The brain can then
recruit enough muscles to open the airway Some research suggests there
might be a neurological component to obstructive sleep apnea Serotonin and
Dopamine levels have been linked to Obstructive Sleep Apnea, both inside
and outside the brain Age is a factor, because of the general loss of
muscle tone, but nobody knows for sure what the underlying cause, or causes
are
Symptoms of OSA
You can probably guess one of the most common symptoms of sleep apnea -
thats right - snoring 50 of chronic snorers have sleep apnea Snoring is
the Hallmark symptom of Sleep Apnea It is important to note though, that
not all Obstructive Sleep Apnea suffers will be snorers Gasping or choking
is often the action that directs the bed partner to seek help The loud
snoring wakens the bed partner; they will look over and see their mate is
not breathing This can
go on for 40, 50, 60 or more seconds It can be a
very frightening thing to see The literature refers to this as Witnessed
Apnea
In some cases of OSA, the patient will self awaken with palpitations or a
racing heart In this case, individuals think they are awaking from a panic
attack - a spike in blood pressure and an increase in heart rate accompany
this arousal These symptoms can be misinterpreted as a panic attack
Daytime sleepiness is a good predictor or sleep apnea, but it is not very
sensitive - many OSA patients little to no daytime sleepiness
We already talked about the increase in auto accidents; the same applies to
the workplace Chronic fatigue can also lead to personality changes A
common complaint of chronic OSA patients is that they get a full 8 hours
sleep, but still wake up tired Look at these last four symptoms; do they
remind you of anything else? They look a lot like depression Anytime there
is a suspicion of depression in a person/patient, you should ask a few
simple questions to see if the person/patient is a candidate for
Obstructive Sleep Apnea diagnosis Depression and OSA are 2 very different
diseases Treating an OSA patient for depression does nothing,
just as
treating a depression patient for OSA does nothing as well However, the
symptoms of the 2 diseases do overlap, and it is important to rule both of
them in, or out
Obesity and OSA
Here are the results of a few studies looking at obesity and Obstructive
Sleep Apnea There is a clear and strong link between obesity and sleep
apnea Fat deposits in the neck narrow the airway, greatly increasing the
chance of acquiring sleep apnea OSA is seen as a disease of obesity, and
this is a fair assumption But dont be fooled, not all of OSA patients are
obese Certain Asian populations have a equal susceptibility to OSA as the
US despite having much lower rates of obesity This is likely due to
Cranial Facial differences Looking at the first study, remember that
although 2/3 of the participants were obese, 1/3 were within 30 of their
ideal bodyweight
Other Signs
Several of these other signs we already talked about Hypertension and
depression are co-symptoms that can mark the presence of OSA Downs
Syndrome can present both structural and obesity related challenges to the
airway
Prevalence
Estimates to the prevalence of Obstructive Sleep Apnea in the Unites States
are 2 for woman,
and 4 for men There are many studies giving higher
prevalence number for specific populations - 9 for middle-aged white
males, up to 24 and even 40 in some populations The links between OSA,
age and obesity, lead most to conclude that the number of Obstructive Sleep
Apnea will continue to grow This prevalence of 18 million people with OSA
is on par with Diabetes and Asthma It is estimated that 50 of the people
that have diabetes, dont know it These are the people commonly referred
to as the missing 10 million There is a lot of effort in healthcare to
reach out to these individuals to encourage treatment The picture for OSA
is bleaker than that; only about 10 of the people suffering for OSA have
been diagnosed Remember that each one of these undiagnosed patients is
costing the health care industry twice as much as everyone else, and
getting into 6 times as many car accidents
Pediatric OSA
This presentation focuses primarily on adults, but it is worth talking
about pediatric patients for a moment Kids are most at risk from the ages
of 3 to 9 During this time, the development of the airway is such that the
tonsils are largest, in relation to the rest of the airway
These
relatively large tonsils and adenoids are the leading cause of OSA in kids
The link between ADD of ADHD and Obstructive Sleep Apnea has received a
lot of attention in the popular press, but they may have overstated the
case The exact overlap between Obstructive Sleep Apnea and ADHD patients
is unclear OSA does result in poor sleep, tired adults get sleepy, tired
kids get cranky fussy, and have a short attention span, just like kids with
ADHD In adults, a suspicion of depression should trigger a suspicion of
OSA In kids, a suspicion of ADHD should trigger a suspicion of OSA as
well Remember, ADHD and Obstructive Sleep Apnea are two very different
diseases, but they share many of the same symptoms The overall prevalence
in kids is about the same as in adults
In summary, we begin with the clinical definition of Obstructive Sleep
Apnea: A total closure of the upper airway resulting in reduction or
cessation of airflow, despite persistent respiratory effort Unfortunately
nobody knows what causes sleep apnea, but major symptoms of the disease
include snoring, gasping and/or choking while sleeping, daytime sleepiness,
and chronic fatigue It should be noted that several of these
symptoms are
similar to those found in adult depression In addition, OSA is more common
in obese patients, than in the rest of the population The prevalence of
OSA in the US is approximately 4 for men, and 2 for woman; and, even more
so than diabetes, a significant portion of people with obstructive Sleep
Apnea has not been diagnosed Finally, we discussed the prevalence of OSA
in children, approximately the same as in the adult population, and noted,
symptoms commonly associated with ADHD, should trigger a suspicion of OSA
as well
Chapter 3: Diagnosis of OSA
Now that we know what Obstructive Sleep Apnea is, and why it is important,
how can we diagnose it?
Definition of AHI
In OSA, diagnosis is made, in large part, by measuring the patients
apnea/hypopnea index Apnea is the cessation of airflow, persisting for 10
or more seconds Hypopnea is the reduction of airflow for 10 or more
seconds accompanied by the reduction of oxygen saturation, or terminated by
arousal Take all the apneas and hypopneas, and divide by the sleep time to
get the AHI or Apnea Hypopnea Index The AHI is the number of apneas and
hypopneas per hour
The RDI, or Respiratory
Disturbance Index can measure OSA; the term RDI is
less specific and well defined than the AHI RDI may include episodes of
upper airway resistance, Cheyne-Stokes breathing, and other related events
that do not fit these definitions of apnea and hypopnea RDI is more
properly associated with sleep disorder breathing, or SDB; a term that
includes Obstructive Sleep Apnea, and is often used interchangeably with
it The literature is moving away from the term RDI however, and toward
AHI It is only by using precisely defined terms that comparisons between
published studies can be made You may also come across those that prefer
the term OSAHS, or Obstructive Sleep Apnea Hypopnea Syndrome, rather than
just OSA This gets back to the idea that we really dont know what causes
OSA, but we do know what it looks like, and what the symptoms are
OSA Severity Defined
The Apnea Hypopnea Index is a critical piece of information in making a
diagnosis in Obstructive Sleep Apnea, but it is not the only one Patients
physical history is important, especially in the milder cases Many things
can affect the AHI, including medications, alcohol, viruses, allergies - a
diagnosis should incorporate many
factors other than AHI Medicare will
authorize care/coverage with the AHI above 5 and symptoms present, or if
the AHI is above 10, regardless of symptoms
Measurement Technologies
There are 2 definitive methods of testing for Obstructive Sleep Apnea The
PSG or Polysonogram, performed over night in a sleep clinic, is the
original Gold Standard for diagnosing Obstructive Sleep Apnea and many
other sleep disorders It has been used since the emergence of sleep as a
branch of medicine Use of at-home testing has increased over the last 10
to 15 years This began in response to rising heath care costs, and has
received renewed interest of late, as the awareness of OSA and its
consequences has increased There is no standard set of leads or signals
associated with either method Each Sleep Lab, each clinician, and each
manufacturer choose the leads they feel appropriate There are standards
that define different levels of testing based upon the number, or types of
leads chosen
PSG Advantages
There are several advantages to the traditional Polysonogram A technician
is present in case there are any problems with the equipment The tech will
apply the sensors and be sure the initial signal
quality is good They will
monitor the equipment throughout the night If a sensor comes loose, of the
signal quality begins to suffer, they can wake the patient and make
adjustments to the sensors They may also make subjective notes on
behaviors such as restlessness and snoring There is a large set of signals
to choose from Patients with a suspicion of OSA might have just a couple
of EEG leads, while a neurological patient may have 16 or more scalp
electrodes There is EEG sensors, EOG and EMG sensors, ECG electrodes,
airflow sensors, finger and ear sensors, leg and arm sensors, and chest and
abdomen sensors, among others The clinician will choose the proper mix of
signals depending on the reason for the referral There are 80 different
sleep disorders; The Polysonogram, with its large compliment of signals and
technicians in attendance, can detect many of them
PSG Disadvantages
There are many disadvantages to the Polysomnogram as well Its expensive;
1,000-3,000 depending on where you reside in the country Backlogs of
sleep labs can vary from a couple of weeks to as much as six months or
more In some populations, such as the VA system, the backlog can be a year
or more The sleep
lab presents a bottleneck for which only so many
patients can be pushed at one time The number of sleep labs cannot keep up
with the growing awareness of Obstructive Sleep Apnea, and this problem
will only get worse as the current population ages Each bed in the clinic
can only test one person a night The patient to tech ratio is 2:1 is some
sleep labs, and 4:1 in others It is difficult to find, train, and retain
Polysomnogram technicians willing to work at night There are no rigorous
scoring standards for tests done in the sleep lab The few standards that
do exist are open to interpretation
There are many papers in the literature that shows that the same study
will score differently at different labs Furthermore, it is shown that the
same study can be reviewed differently in the same clinic, and even by the
same reviewer, at different times The definitions given earlier for apnea
and hypopnea are standard, but they are not comprehensive For example,
hypopnea is the reduction in airflow accompanied by a desaturation, or
terminated by an arousal The amount of airflow is not specified, and
varies widely in definition The amount of desaturation is not defined as
well Two common
practices require that the desaturation be either 3 or 4
to score a hypopnea These differences in scoring make it important to get
to know your sleep clinic, and its practices They also make it difficult
to implement treatment standards if your patients are being referred to
more than one lab
A Polysomnogram is inconvenient The patient must go the lab and spend the
night there This may only be a nuisance in a metropolitan area It can be
a significant barrier to testing in rural areas where travel times of 5 to
7 hours are not uncommon The results of sleep studies performed are often
skewed by what is called a first night effect A patient is wired up with
10 or more sensors, most of them on the head They are placed in a strange
bed A video camera is pointed at them A technician will be watching them
- and they are told to sleep normally This unnatural and intrusive
setting alters the patients normal sleep patterns These studies are more
accurate if repeated on a second night There are many articles in the
Sleep Study literature that discuss this first night effect
Ambulatory Advantages
Ambulatory, or portable monitoring, done at home, has its own set of
advantages and
disadvantages Among the advantages, patients sleep at home
Research has shown that when the sleep tests are done at home, the patient
does not suffer from the first night effect Ambulatory testing can also
be done in a nursing home, hospital, hotel, or any other convenient
location The cost is lower, just how much lower depends on the cost of
clinics in your area Savings of a 1/3 to 1/2 are common Ambulatory
devices allow sleep labs to perform more tests than they have beds This
increases the number of patients a clinic can diagnose But there are still
factors that contribute to a bottleneck even with ambulatory testing Well
talk about those shortly
Ambulatory Disadvantages
Of course ambulatory testing has disadvantages as well Ambulatory
diagnostic devices still require a technical to apply the sensors to the
patient This may be done in the office or the patients home This need
for a technician limits the number of patients that can be diagnosed and
does not eliminate the geographic constraints of the sleep lab Signal
quality may be a problem Sensors are validated when they are applied But
the typical ambulatory device is a simple data recorder The signals are
not validated
throughout the night If a sensor comes loose, or the signal
quality is reduced, the study may need to be repeated, because this poor
signal quality may not be discovered until the next morning when data
accumulation takes place
As with the sleep lab, there is no standardized scoring Many ambulated
systems provide automated scoring, but they provide customizable rules, and
even then, are often not used Interscore and Intrascore repeatability
problems remain Published, peer review validation of these [ambulated]
systems is lacking Finally, the patient must still go to the lab to get
hooked up, and then drive home with wires hanging off their head Some
providers use a DME model where the technician goes to the patients house
and hooks them up Either method will not resolve the bottlenecking that
occurs with the OSA testing backlogs It should also be noted that
ambulatory devices often have far fewer signals then the Polysomnogram and
therefore cant diagnose as many of the sleep disorders as the clinic
However, most patients studied in a sleep lab have a suspicion of
Obstructive Sleep Apnea, and most ambulatory devices have sufficient
signals to detect OSA
Chapter 4: Treatment
Introduction
So at this point we know what Obstructive Sleep Apnea is, why it is
important, and how it can be diagnosed What can we do about it?
Treatment Options
Weight loss is an effective treatment for the obese patient Weight loss
studies have shown that as the body mass index BMI goes down, the Apnea
Hypopnea Index AHI goes down as well While generally effective,
effective weight loss requires a life style change, which can be difficult
to initiate, and even more difficult to sustain, and naturally, it has no
effect on non-obese patients
CPAP, or continuous positive airway pressure, is the most effective
treatment for Obstructive Sleep Apnea If used properly and consistently,
it is highly effective in virtually every patient There are several
variants of CPAP, Bi-level CPAP BIPAP, Auto CPAP, Etc Tonsillectomy and
Adenoidectomy is the preferred treatment for children, and is almost always
effective The results for surgery in adults are mixed however There are
many different kinds of surgeries Radio Frequency Ablation creates
scarring to stiffen the palette Splints can be inserted into the palette
for the same reason LAUPP or Laser Assisted
Uvulo-Palato-Plasty,
Mandibular Advancement - effective, but major surgery; and methods to
tighten, advance, and tie down, or otherwise keep the tongue from falling
back into the throat can be complicated procedures, to say the least
Surgical interventions typically measure success as a percentage reduction
in the AHI The AHI is often still above the threshold of OSA - and there
is a fair chance of recurrence after several years Still in all, surgery
is a viable option, especially for the non-compliant CPAP user Oral
appliances are worn at night, to temporarily advance the mandible They may
be used in conjunction with CPAP The attitude of the sleep community
regarding oral appliances is mixed, and this is an area of treatment that
is still undergoing significant development People are now beginning to
look at the long-term consequences of wearing an oral appliance every
night, such as changes in the teeth and jaw There is one treatment not
listed here: positional treatment Sewing a tennis ball into the back of
the nightshirt; this treatment has been largely discarded by the sleep
community as being insufficiently effective, and also difficult to manage
Of these treatments, CPAP
is the overwhelming treatment of choice in the
sleep community Surgery would be suggested only after earnest trials of
CPAP have proven ineffective Drug therapy is the goal for many in the
sleep community There have been some promising early trials, but there is
currently no drug treatment for Obstructive Sleep Apnea, and no compounds
are near release that has an acceptable efficacy, or side effect profile
CPAP
A mask through the patients nose delivers continuous Positive Airway
Pressure CPAP A constant stream of room air, often heated and
humidified, is sent from a small blower at the patients bedside The
pressure is not enough to interfere with normal breathing, but it is
thought that the stimulation of the airflow on the upper airway is enough
to keep the airway open Each patient requires a different amount of
airflow The effective airflow for each patient is traditionally obtained
in the sleep lab as part of a titration study In some labs, this study may
be done on the same night as the sleep study - a so-called Split Night
Study In others, a titration study is done on the following night
The technical applies the CPAP and sets the pressure value; the value is
increased or
decreased, until the lowest effective level is found The
patient is then provided with a CPAP machine fixed at that setting This
model of treatment suffers from the same problems as in-lab diagnostic
testing It requires trained technicians in a sleep clinic The Patient
encounters the same backlog, the same bottleneck, and inconvenience If the
time between diagnosis and treatment is prolonged because of accessibility,
the risk of legal liability may become an issue
CPAP is a treatment, nothing more It is not a cure It is worn, every
night The effect on the Apnea/Hypopnea index and overall sleep is
immediate Patients often report waking up the next morning, feeling like a
new person The effect on nocturnal blood pressure is immediate as well A
drop in daytime blood pressure may be seen in a few days or weeks All of
these effects are reversed if the CPAP is not worn The American Thoracic
Society has an official statement on this matter, CPAP is effective in
eliminating Obstructive Sleep Apnea, Oxyhemoglobin desaturation, and
respiratory related arousal from sleep CPAP is also associated with
improved morbidity as manifested in primarily a reduction is daytime
sleepiness, and
improved cardiopulmonary function Although the long term
effects of nasal CPAP have not been fully determined, available data
suggests a possible reduction in mortality
Auto CPAP
Auto CPAP is a newer variant that continuously monitors the patient and
sets the air pressure to the lowest value that prevents obstruction This
value may change during the night, and may change over weeks and years
Patients report increased comfort with Auto CPAP, since they are generally
exposed to lower pressures throughout the night
Auto CPAP can be used in lieu of traditional titration when the patient
uses auto titration for one or more nights The clinician reads the profile
of the pressure that was used during the trial, to determine the pressure
the fixed CPAP unit will have Alternatively, Auto CPAP can be used on a
permanent basis In this scenario, no titration is necessary, because the
device is self Titrating This model of therapy, is gaining popularity
because of its simplicity and increased patient comfort However, there are
not enough outcome studies to show it is more cost effective than fixed
CPAP It is significantly more expensive; therefore most reimbursement
today is for fixed
CPAP
CPAP Compliance
Many studies of CPAP compliance rates have been done Those that use
objectively and usually covertly measured compliance, report long-term
compliance rates of 41-73, with most in the 60 range These rates go up
considerably with a compliance program Key elements to achieving good
compliance are education, comfort, and follow-up Patients that understand
the long-term consequences of their disease are more likely to be
compliant Likewise, a proactive follow-up program can provide needed
encouragement and earlier identification of problems
With regard to humidification: Generally speaking it is advantageous to
incorporate [heated] humidification into a CPAP/BIPAP delivery device The
human nose heats and humidifies the air we breathe during the course of a
normal human breath When delivering an artificial breath, as with a CPAP
or BIPAP machine, often times the flow of air is too fast for the nose to
do its job Many times this leads to dried sinuses, and can cause a great
deal of irritation and discomfort for the user Heated humidification has
been proven clinically to adequately heat and humidify the artificial
CPAP/BIPAP breath to mimic that function
normally handled by the nose
In Closing
We here at Express CPAP Supply wwwyouneedsleepcom hope that you have
found this information useful I have discovered, over the course of the
last 18 years of being a Respiratory Therapist, that CPAP users are
generally very informed with regard to their illness, and the treatment of
that illness I find this encouraging, because I realize the importance of
effectively treating this insidious, and under-diagnosed disease
For sales help on new CPAP equipment and supplies, please contact:
mailto:sales@youneedsleepcom
If you have any further questions, please feel free to contact the author
of this eBook at the following email address:
Mark@youneedsleepcom
References:
1 Nieto et al 2000 Association of Sleep-Disordered Breathing, Sleep
Apnea, and Hypertension in a Large Community-Based Study JAMA
14214: 1829-1836
2 Sin et al 2003 Relationship of Systolic BP to OSA in Patients with
Heart Failure Chest 123: 1536-1543
3 Khoo et al 2001 Cardiac autonomic control in
OSA - Effects of Long-
term CPAP Therapy AJRCCM 164: 807-812
4 Peker et al 2002 Increased Incidence of Cardiovascular Disease in
Middle-aged Men with Obstructive Sleep Apnea AJRCCM 165: 159-165
5 Peker et al 200 RDI: An independent predictor of mortality in
coronary artery disease AJRCCM 162: 81-86
6 Teran-Santos et al The association between Sleep apnea and the risk
of traffic accidents NEJM 340: 847-851
7 Ip et al 2002 OSA Is Independently Associated with Insulin
Resistance AJRCCM 165: 670-676
8 Silvestrini et al 2004 Carotid Artery Wall Thickness in Patients
with OSA Stroke 33: 1782-1785
9 Kapur et al 1999 The Medical Cost of Undiagnosed Sleep Apnea Sleep
226:749-755
10 Claman et al 2001 Clinical validation of the Bedbugg in detection of
obstructive sleep apnea Otolaryngology - Head and Neck Surgery 125:
227-230
11 Reichert et al 2003 Comparison of the NovaSom QSG, as new sleep
apnea home-diagnostic system, and polysomnography Sleep Medicine 4:
213-218
12 Le Bon et al 2000 Mild to Moderate Sleep Respiratory Events: One
negative night may not be enough Chest 118:353-359
13
Namen et al 2002 Increased Physician-Reported Sleep Apnea Chest
121; 1741-1747
14 Nieto et al 2002 Association of SDB, Sleep Apnea, and hypertension
in a large community-based study Sleep Heart Health Study: JAMA Vol
14214: 1829-1836
