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Review
. 2021 Jan;18(1):81-90.
doi: 10.1007/s13311-020-00955-x. Epub 2020 Nov 4.

Sleep-Related Breathing Disorders: When CPAP Is Not Enough

Bernardo Selim  1 , Kannan Ramar  2
Affiliations
Review

Sleep-Related Breathing Disorders: When CPAP Is Not Enough

Bernardo Selim et al. Neurotherapeutics. 2021 Jan.

Abstract

Three decades ago, continuous positive airway pressure (CPAP) was introduced to treat obstructive sleep apnea (OSA). Shortly after, bilevel positive airway pressure devices (BPAP) that independently adjusted inspiratory and expiratory positive airway pressure were developed to treat complex sleep-related breathing disorders unresponsive to CPAP. Based on the bilevel positive airway pressure platform (hardware) governed by propriety algorithms (software), advanced modes of noninvasive ventilation (NIV) were developed to address complex cardiorespiratory pathophysiology beyond OSA. This review summarizes key aspects of different bilevel PAP therapies (BPAP with/without backup rate, adaptive servoventilation, and volume-assured pressure support) to treat common sleep-related hypoventilation disorders, treatment-emergent central sleep apnea, and central sleep apnea syndromes.

Keywords: Adaptive servoventilation (ASV); Bilevel positive airway pressure (BPAP); Central sleep apnea; Sleep-related hypoventilation; Treatment-emergent central apnea; Volume-assured pressure support (VAPS).

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Figures

Fig. 1
Fig. 1
(A) CPAP vs NIV in respiratory support. (B) Components of a single-limb circuit NIV. CPAP = continuous positive airway pressure; FRC = functional residual capacity; NIV = noninvasive ventilation; Vt = tidal volume; RR = respiration rate; UA = upper airway
Fig. 2
Fig. 2
(A–D) Noninvasive ventilation waveforms. ASV = adaptive servoventilation; CSA = central sleep apnea; EPAP = expiratory positive airway pressure; IPAP = inspiratory positive airway pressure; IPAP min. = minimal inspiratory positive airway pressure; IPAP max. = maximal inspiratory positive airway pressure; OSA = obstructive sleep apnea; CSR = Cheyne–Stokes respiration; PS = pressure support; RR = respiratory rate; Vt = tidal volume; Vte = expiratory tidal volume; VAPS = volume-assured pressure support
See this image and copyright information in PMC

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