New Guidelines Validate CPAP as the Standard Treatment for Sleep Apnea

WESTCHESTER, Ill. New practice parameters published by the American Academy of Sleep Medicine in the March 1 issue of the journal Sleep validate continuous positive airway pressure, CPAP, as the standard of care for treating adults with moderate to severe obstructive sleep apnea, OSA.

CPAP is the most effective therapy we have for treating patients with sleep apnea, a disorder that can contribute to the development of hypertension and heart disease, said Lawrence J. Epstein, M.D., president of the American Academy of Sleep Medicine. It is immediately effective, relatively noninvasive and usually well tolerated.

OSA afflicts an estimated 15 million to 20 million Americans, the majority of whom remain undiagnosed and untreated. Men are twice as likely as women to develop sleep apnea, with excessive weight being the primary risk factor. OSA is much more common in women as they enter menopause.

CPAP delivers pressurized airflow to sleep apnea patients who wear a mask that covers the nose as they sleep. The steady flow of air from the CPAP machine keeps the airway open and prevents the pauses in breathing that characterizeOSA.

These pauses in breathing can occur a few times an hour or even hundreds of times per night, resulting in severely disrupted sleep, excessive daytime sleepiness, and an increased risk of high blood pressure, stroke, and other forms of cardiovascular disease.

CPAP Provides Additional Benefits

The practice parameters indicate that in addition to preventing pauses in breathing and restoring oxygen levels, CPAP improves self-reported sleepiness in patients with OSA and may also improve their overall quality of life.

Patients often express dramatic improvements in how they feel, often after the first night, said Epstein. They are more alert, have more energy and are able to perform at higher levels for longer periods of time.

The parameters, which were based on an accompanying review of the evidence found in the scientific literature, suggest that physicians may choose to use CPAP as a part of their patient-care strategy to lower blood pressure in hypertensive patients with OSA. CPAP is also presented as a treatment option that clinicians may recommend for patients with mild cases of OSA.

Involvement of a Sleep Specialist is Important for Treatment Success

According to the parameters, a trained sleep physician plays a critical role in the initiation and maintenance of a patient's CPAP treatment. Treatment with CPAP must be based on both a prior diagnosis of OSA and a systematic process of titration that determines the optimal level of air pressure for the individual patient's needs. An overnight sleep study, or polysomnogram, conducted in a sleep center or laboratory is essential for both of these requirements.

In order to establish and maintain a long-term adherence to CPAP, the parameters also recommend that trained health care providers conduct follow-up of patients, especially during the first few weeks of treatment. Patients should also schedule annual follow-up appointments with a sleep specialist who can troubleshoot problems and make any necessary adjustments to their air pressure level.

The following list shows common factors and warning signs in the development of OSA. Discuss these statements with your doctor or a sleep specialist if any of them describe your health and your sleep:

- You are overweight with a body mass index (BMI) of 25 or more

- You are a man with a neck size of 17 inches or more

- You are a woman with a neck size of 16 inches or more

- You have high blood pressure

- You are a menopausal or postmenopausal woman

- You snore loudly and frequently

- You make choking or snorting sounds during sleep

- You stop breathing during sleep

- You normally feel tired even after a full night of sleep

- You fall asleep while driving or during periods of daytime inactivity

- You have a family member who has sleep apnea

Sleep is the official journal of the Associated Professional Sleep Societies LLC, a joint venture of the American Academy of Sleep Medicine and the Sleep Research Society. Go online to www.journalsleep.org for more information.