CPAP stands for “continuous positive airway pressure” and means that the affected person is ventilated at night with positive pressure via a breathing mask. Due to the continuous positive pressure with which the breathing air is supplied, the airways cannot close. The affected person therefore no longer snores or has breathing pauses. The procedure is used for obstructive sleep apnea (OSA). CPAP therapy reduces OSA-associated morbidity (disease incidence) for obesity, hypertension (high blood pressure), diabetes mellitus, and cardio- and cerebrovascular disease, as well as their mortality (death rate).In a large cohort study using the Danish National Patient Registry, the following was found regarding mortality:
- Positive effect on mortality in middle-aged men and above.
- No significant effect on mortality in women; women appear to have a lower risk of dying from the effects of OSA.
A meta-analysis of cohort studies also demonstrated that CPAP therapy was associated with a 42% lower risk of atrial fibrillation recurrence. Another benefit of CPAP is dementia prevention: the ADNI (Alzheimer’s Disease Neuroimaging Initiative) study demonstrated that symptoms of dementia begin an average of 10 years later with CPAP than without CPAP.
Indications (areas of use)
- Obstructive sleep apnea syndrome (OSAS) – this causes severe relaxation of the annular muscles around the upper airway during sleep. The upper part of the trachea collapses as a result and obstruction (obstruction) of the airway occurs.
The procedure
The device is placed next to the bed. The patient puts on a fitted nasal mask, which is connected to the device via a long tube. The latest generation devices, in particular, operate almost noiselessly and are therefore not perceived as annoying. They comply with a guideline value of < 30 dB(A) for undisturbed sleep (according to WHO). The devices are connected to the power outlet via a power cable, and 12/24 volt power adapters are also available to allow them to be used outside the home, such as in a mobile home. The breathing masks have also become much smaller these days and are more like oxygen goggles than large masks. The exact procedure is discussed and tested with the patient in the sleep lab. The positive pressure ventilator is also adjusted there. CPAP therapy is usually well tolerated and tolerated. However, the nasal mask must be worn every night, as the mask does not cure the condition. When the CPAP mask is no longer worn, the symptoms of sleep apnea will return. More than 80% of sufferers benefit from this method, which is the method of first choice for obstructive sleep apnea. The quality of life increases enormously again. This therapy leads to restful sleep and thus to a decrease in other symptoms such as daytime sleepiness. In your own interest, you should participate in regular control examinations, these should usually be carried out once a year, in order to be able to detect possible limitations due to the pressure load as early as possible.
Possible complications
The main side effects of CPAP ventilation are possible drying of the airways and pressure sores if the breathing mask does not fit properly. Airway drying can be compensated for by humidifying the breathing air. Newer devices often have a heated and adjustable humidifier. Pressure points can be prevented by precise adjustment of the breathing mask. Other side effects can include eye irritation due to mismatched or leaking tubing. After four to five years, the CPAP positive pressure device is replaced by the health insurance company. Further notes
- A network meta-analysis of CPAP therapy and protrusion splint (snoring splint) demonstrated that systolic and diastolic blood pressure decreased significantly:
- A meta-analysis of ten controlled trials showed no robust evidence of reduction in cardiovascular risks (myocardial infarctions, cerebral infarctions, heart failure, and deaths) with positive pressure ventilation.
- CPAP treatment had a positive effect on sexual quality of life in women (difference: 1.34; 95% confidence interval, 0.50-2.18; effect size, 0.87); this was not true for men (effect size: 0.19).
The differences between the 2 therapies were not significant.
