Neuere Entwicklungen der X-PAP-Therapie für obstruktive und zentrale schlafbezogene Atmungsstörungen

Schlussfolgerungen

Die Therapie mit CPAP ist in den meisten Fällen bei obstruktiver Schlafapnoe erfolgreich. Bei nicht ausreichender Adhärenz bieten CPAP-Variationen die Möglichkeit der Differenzialtherapie. Objektive, relevante Verbesserungen der Adhärenz durch verschiedene Druckentlastungsverfahren konnte in Untergruppen von OSA nachgewiesen werden. Die adaptive Servoventilation (S-PAP) stellt bei CSA/CSR-Atmung eine Methode dar, die gegenüber CPAP effektiver sein dürfte. Durch gute Betreuung in der Kombination mit dem Einsatz optimierter Druckverfahren kann die Adhärenz von Patienten mit SBAS günstig beeinflusst werden.

• Literatur

• 1 Galetke W, Puzzo L, Priegnitz C et al. Long-term therapy with continuous positive airway pressure in obstructive sleep apnea: adherence,side effects and predictors of withdrawal – a ‛real-life’ study. Respiration 2011; 82: 155-161
• 2 Weaver TE, Maislin G, Dinges DF et al. Relationship between hours of CPAP use and achieving normal levels of sleepiness and daily functioning. Sleep 2007; 30: 711-9
• 3 Lewis KE, Seale L, Bartle IE et al. Early predictors of CPAP use for the treatment of obstructive sleep apnea. Sleep 2004; 27: 134-138
• 4 Kushida CA, Littner MR, Hirshkowitz M. American Academy of Sleep Medicine et al. Practice parameters for the use of continuous and bilevel positive airway pressure devices to treat adult patients with sleep-related breathing disorders. Sleep 2006; 29: 375-380
• 5 Parke RL, Eccleston ML, McGuinness SP. The effects of flow on airway pressure during nasal high-flow oxygen therapy. Respir Care 2011; 56: 1151-1155
• 6 McGinley BM, Patil SP, Kirkness JP et al. A nasal cannula can be used to treat obstructive sleep apnea. Am J Respir Crit Care Med 2007; 176: 194-200
• 7 Nilius G, Wessendorf T, Maurer J et al. Predictors for treating obstructive sleep apnea with an open nasal cannula system (transnasal insufflation). Chest 2010; 137: 521-528
• 8 Ruhle KH, Domanski U, Nilius G. Obstructive pressure peak: a new method for differentiation of obstructive and central apneas under auto-CPAP therapy. Sleep Breath 2013; 17: 111-115
• 9 Randerath WJ, Schraeder O, Galetke W et al. Autoadjusting CPAP therapy based on impedance efficacy, compliance and acceptance. Am J Respir Crit Care Med 2001; 163: 652-657
• 10 Massie CA, McArdle N, Hart RW et al. Comparison between automatic and fixed positive airway pressure therapy in the home. Am J Respir Crit Care Med 2003; 167: 20-23
• 11 Sériès F, Marc I. Importance of sleep stage- and body position-dependence of sleep apnoea in determining benefits to auto-CPAP therapy. Eur Respir J 2001; 18: 170-175
• 12 Smith I, Lasserson TJ. Pressure modification for improving usage of continuous positive airway pressure machines in adults with obstructive sleep apnoea. Cochrane Database Syst Rev 2009; CD003531
• 13 Ayappa I, Norman RG, Whiting D et al. Irregular respiration as a marker of wakefulness during titration of CPAP. Sleep 2009; 32: 99-104
• 14 Rühle KH, Karweina D, Domanski U et al. Clinical views on biosignal processing of ventilation in sleep medicine. Pneumologie 2011; 65: 89-93
• 15 Dungan 2nd GC, Marshall NS, Hoyos CM et al. A randomized crossover trial of the effect of a novel method of pressure control (SensAwake)in automatic continuous positive airway pressure therapy to treat sleep disordered breathing. J Clin Sleep Med 2011; 7: 261-267
• 16 Sanders MH, Kern N. Obstructive sleep apnea treated by independently adjusted inspiratory and expiratory positive airway pressures via nasal mask. Physiologic and clinical implications. Chest 1990; 98: 317-324
• 17 Sanders MH, Montserrat JM, Farré R et al. Positive pressure therapy: a perspective on evidence-based outcomes and methods of application. Proc Am Thorac Soc 2008; 5: 161-172
• 18 Resta O, Guido P, Picca V et al. Prescription of nCPAP and nBIPAP in obstructive sleep apnoea syndrome: Italian experience in 105 subjects. A prospective two centre study. Respir Med 1998; 92: 820-827
• 19 Schwartz SW, Rosas J, Iannacone MR et al. Correlates of a prescription for Bilevel positive airway pressure for treatment of obstructive sleep apnea among veterans. J Clin Sleep Med 2013; 9: 327-335
• 20 Rühle KH, Domanski U, Happel A et al. Analysis of expiratory pressure reduction (C-Flex method) during CPAP therapy]. Pneumologie 2007; 61: 86-89
• 21 Nilius G, Happel A, Domanski U et al. Pressure-relief continuous positive airway pressure vs constant continuous positive airway pressure: a comparison of efficacy and compliance. Chest 2006; 130: 1018-1024
• 22 Ballard RD, Gay PC, Strollo PJ. Interventions to improve compliance in sleep apnea patients previously non-compliant with continuous positive airway pressure. J Clin Sleep Med 2007; 3: 706-712
• 23 Powell ED, Gay PC, Ojile JM et al. A pilot study assessing adherence to auto-bilevel following a poor initial encounter with CPAP. J Clin Sleep Med 2012; 8: 43-47
• 24 Nilius G, Burian S, Franke KJ et al. Effects of a breath-triggered modulation of positive airway pressure ventilation on the AHI from patients with obstructive sleep apnoea. Pneumologie 2009; 63: 433-438
• 25 Chihara Y, Tsuboi T, Hitomi T et al. Flexible positive airway pressure improves treatment adherence compared with auto-adjusting PAP. Sleep 2013; 36: 229-236
• 26 Colrain IM, Brooks S, Black J. A pilot evaluation of a nasal expiratory resistance device for the treatment of obstructive sleep apnea. J Clin Sleep Med 2008; 4: 426-433
• 27 Berry RB, Kryger MH, Massie CA. A novel nasal expiratory positive airway pressure (EPAP) device for the treatment of obstructive sleep apnea: a randomized controlled trial. Sleep 2011; 34: 479-485
• 28 Kryger MH, Berry RB, Massie CA. Long-term use of a nasal expiratory positive airway pressure (EPAP) device as a treatment for obstructive sleep apnea (OSA). J Clin Sleep Med 2011; 7: 449-453
• 29 Braga CW, Chen Q, Burschtin OE et al. Changes in lung volume and upper airway using MRI during application of nasal expiratory positive airway pressure in patients with sleep-disordered breathing. J Appl Physiol 2011; 111: 1400-1409
• 30 Sharma BK, Bakker JP, McSharry DG et al. Adaptive servoventilation for treatment of sleep-disordered breathing in heart failure: a systematic review and meta-analysis. Chest 2012; 142: 1211-1221
• 31 Kasai T, Usui Y, Yoshioka T et al. Effect of flow-triggered adaptive servo-ventilation compared with continuous positive airway pressure in patients with chronic heart failure with coexisting obstructive sleep apnea and Cheyne-Stokes respiration. Circ Heart Fail 2010; 3: 140-148
• 32 Randerath WJ, Nothofer G, Priegnitz C et al. Long-term auto-servoventilation or constant positive pressure in heart failure and coexisting central with obstructive sleep apnea. Chest 2012; 142: 440-447
• 33 Zeller J, Hetzenecker A, Arzt M. Sleep-disordered breathing in patients with chronic heart failure: epiphenomenon or bidirectional relationship. Pneumologie 2013; 67: 150-156