Web Integrated Continuous Positive Airway Pressure System

Continuous positive airway pressure (CPAP) systems for preterm infants work with conventional ventilators or use a jet ventilation system. It is assumed that the most important advantage of jet-CPAP systems is a lower expiratory resistance (R(E) ). We investigated the R(E) of seven different CPAP systems. We studied two primary-care CPAP systems, three jet-CPAP generators, and two conventional CPAP devices. All devices were adjusted at 6 mbar and connected with a test lung simulating a standardized expiration volume. Maximum pressure increase during expiration was measured and maximum R(E) was calculated. In primary-care CPAP devices, the maximum R(E) of the Benveniste valve was 9.7 mbar/L/s (SD 1.2) while that of the Neopuff was 102.8 mbar/L/s (SD 7.9) (P < 0.01). In jet-CPAP devices, the R(E) of the Infant Flow was 6.8 mbar/L/s (SD 1.7), the one of the Medijet REF 1000 was 43.5 mbar/L/s (SD 1.5), and that of the Medijet REF 1010 was 36.7 mbar/L/s (SD 0.3) (P < 0.01). In conventional CPAP systems, the R(E) of the Baby Flow was 29.7 mbar/L/s (SD 1.1) and that of the Bubble CPAP was 37.1 mbar/L/s (SD 4.3) (P < 0.01). All CPAP devices created an R(E). Jet-CPAP devices did not produce lower R(E) than conventional CPAP devices.

We compared the effectiveness of a new continuous positive airway pressure (CPAP) device (neonatal helmet CPAP) with a conventional nasal CPAP system in preterm neonates needing continuous distending pressure. Randomized, physiological, cross-over study in a tertiary referral, neonatal intensive care unit in a university teaching hospital. Twenty very low birth weight infants with a postnatal age greater than 24 h who were receiving nasal CPAP for apnea and/or mild respiratory distress were enrolled. CPAP delivered by neonatal helmet CPAP and nasal CPAP in random order for two subsequent 90-min periods. Were continuously measured the Neonatal Infant Pain Scale (NIPS) score, oxygen requirements, respiratory rate, heart rate, oxygen saturation, transcutaneous PO(2) (tcPO(2)) and PCO(2) (tcPCO(2)), blood pressure, and desaturations. NIPS scores were significantly lower when the infants were on the neonatal helmet CPAP than when they were on nasal CPAP (0.26+/-0.07 vs. 0.63+/-0.12). The other studied parameters did not differ between the two CPAP modes. The number of desaturations was reduced during the neonatal helmet CPAP treatment (18 vs. 32), although this difference was not significant. In this short-term physiological study the neonatal helmet CPAP appears to be as good as the golden standard for managing preterm infants needing continuous distending pressure, with enhanced tolerability. Further evaluation in a randomized clinical trial is needed to confirm these findings.

When Is CPAP an Antihypertensive in Sleep Apnea Patients?

The purpose of this study is to conduct a systematic review and meta-analysis evaluating the effects of respiratory muscle therapy (ie, oropharyngeal exercises, speech therapy, breathing exercises, wind musical instruments) compared with control therapy or no treatment in improving apnea-hypopnea index ([AHI] primary outcome), sleepiness, and other polysomnographic outcomes for patients diagnosed with obstructive sleep apnea (OSA). Only randomized controlled trials with a placebo therapy or no treatment searched using PubMed, EMBASE, Cochrane, and Web of Science up to November 2018 were included, and assessment of risk of bias was completed using the Cochrane Handbook. Nine studies with 394 adults and children diagnosed with mild to severe OSA were included, all assessed at high risk of bias. Eight of the 9 studies measured AHI and showed a weighted average overall AHI improvement of 39.5% versus baselines after respiratory muscle therapy. Based on our meta-analyses in adult studies, respiratory muscle therapy yielded an improvement in AHI of -7.6 events/h (95% confidence interval [CI] = -11.7 to -3.5; P ≤ .001), apnea index of -4.2 events/h (95% CI = -7.7 to -0.8; P ≤ .016), Epworth Sleepiness Scale of -2.5 of 24 (95% CI= -5.1 to -0.1; P ≤ .066), Pittsburgh Sleep Quality Index of -1.3 of 21 (95% CI= -2.4 to -0.2; P ≤ .026), snoring frequency (P = .044) in intervention groups compared with controls. This systematic review highlights respiratory muscle therapy as an adjunct management for OSA but further studies are needed due to limitations including the nature and small number of studies, heterogeneity of the interventions, and high risk of bias with low quality of evidence.

The aim of this umbrella review was to assess the effectiveness of oral appliance therapy compared to continuous positive airway pressure (CPAP), surgery, inactive appliances/controls, exercise, or other conservative techniques in mitigating symptoms among adults diagnosed with obstructive sleep apnea. Sleep-disordered breathing encompasses a spectrum of recurrent episodes of upper airway narrowing during sleep, marked by symptoms such as snoring, heightened upper airway resistance, or obstructive sleep apnea. The management of obstructive sleep apnea involves a range of conservative and surgical approaches. Among conservative methods, oral appliances are the preferred treatment for primary snoring, mild to moderate cases, and severe cases in patients who are intolerant to CPAP. While several systematic reviews have explored the effectiveness of oral appliance therapy for obstructive sleep apnea, there has been no comprehensive evaluation or synthesis of these reviews. Systematic reviews, with or without meta-analysis, were examined to assess the effectiveness of various forms of oral appliances in treating obstructive sleep apnea. Polysomnography was employed as the method for evaluating the effectiveness of the appliance. The primary outcome of interest was the effectiveness of oral appliance therapy in reducing the apnea-hypopnea index. Secondary outcomes included the mean change in the respiratory arousal index, Epworth Sleepiness Scale scores, minimum oxygen saturation, sleep efficiency, rapid eye movement sleep, blood pressure, quality of life, patient preference, and adverse effects. A comprehensive search was conducted up to October 2023 in MEDLINE (Ovid), CINAHL (EBSCOhost), Scopus, Web of Science Core Collection, Epistemonikos, ProQuest Dissertations and Theses, Shodhganga, and the Cochrane Database of Systematic Reviews. Supplementary searches were manually performed using Google Scholar. The critical appraisal and data extraction processes were carried out independently by 2 reviewers. The extracted data were summarized using a tabular format accompanied by supporting text. The quality of evidence was evaluated utilizing the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. This umbrella review incorporated 27 systematic reviews published between 2004 and 2022. The primary studies in these systematic reviews were published between 1996 and 2021. Of the 68 primary studies, 50 were published between 1996 and 2014 and 18 were published between 2015 and 2021. The corrected covered area index was 15.04%, indicating very high overlap between the primary studies included in the systematic reviews. All systematic reviews that compared oral appliances with CPAP consistently reported that CPAP was more efficacious, evidenced by a decrease in the apnea-hypopnea index, respiratory arousal index, and improved minimum oxygen saturation levels. However, patient preference favored oral appliances over CPAP. Additionally, oral appliances demonstrated improvements in subjective sleepiness scores and indices including the apnea-hypopnea index and respiratory arousal index when compared with inactive appliances/controls. The overall quality of evidence using GRADE ranged from very low to moderate. CPAP demonstrated greater efficacy than oral appliances in reducing the apnea-hypopnea index and respiratory arousal index while increasing minimum oxygen saturation levels, indicating significant improvements in obstructive sleep apnea and contributing to enhanced sleep quality and overall health. Despite these advantages, patient preference often leans toward oral appliances over CPAP. Compared with inactive appliances/controls, surgery, and other conservative management approaches, oral appliances have also shown efficacy in improving obstructive sleep apnea. This umbrella review reinforces CPAP as the gold standard for obstructive sleep apnea treatment, although oral appliances represent a viable alternative, particularly for patients who experience difficulties in accessing or tolerating CPAP. The majority of included systematic reviews were published over a decade ago, highlighting a research gap in this area; therefore, future studies should focus on comparing newer treatment options for obstructive sleep apnea.

ObjectivesThe variable-flow flow driver (FD; EME) and continuous-flow bubble (Fisher-Paykel) continuous positive airway pressure (CPAP) systems are widely used. As these differ in cost and technical requirements, determining comparative efficacy...

Effects of using in-line bacterial filters with continuous positive airway pressure devices in patients with sleep disordered breathing

Positive airway pressure (PAP) devices are used to treat patients with sleep related breathing disorders (SRBD) including obstructive sleep apnea (OSA). Currently, PAP devices come in three forms: (1) continuous positive airway pressure (CPAP), (2) bilevel positive airway pressure (BPAP), and (3) automatic self-adjusting positive airway pressure (APAP). After a patient is diagnosed with OSA, the current standard of practice involves performing full, attended polysomnography during which positive pressure is adjusted to determine optimal pressure for maintaining airway patency. This titration is used to find a fixed single pressure for subsequent nightly usage. A task force of the Standards of Practice Committee of the American Academy of Sleep Medicine reviewed the available literature. Based on this review, the Standards of Practice Committee developed these practice parameters as a guideline for using CPAP and BPAP appropriately (an earlier review and practice parameters for APAP was published in 2002). Major conclusions and current recommendations are as follows: 1) A diagnosis of OSA must be established by an acceptable method. 2) CPAP is effective for treating OSA. 3) Full-night, attended studies performed in the laboratory are the preferred approach for titration to determine optimal pressure; however, split-night, diagnostic-titration studies are usually adequate. 4) CPAP usage should be monitored objectively to help assure utilization. 5) Initial CPAP follow-up is recommended during the first few weeks to establish utilization pattern and provide remediation if needed. 6) Longer-term follow-up is recommended yearly or as needed to address mask, machine, or usage problems. 7) Heated humidification and a systematic educational program are recommended to improve CPAP utilization. 8) Some functional outcomes such as subjective sleepiness improve with positive pressure treatment in patients with OSA. 9) CPAP and BPAP therapy are safe; side effects and adverse events are mainly minor and reversible. 10) BPAP may be useful in treating some forms of restrictive lung disease or hypoventilation syndromes associated with hypercapnia.

Automatic CPAP titration with different self-setting devices in patients with obstructive sleep apnoea.

Outpatient initiation of long-term continuous positive airway pressure in children.

Obstructive sleep apnea (OSA) is a prevalent disorder that is commonly managed with continuous positive airway pressure (CPAP) therapy. Although CPAP is clinically effective, issues related to device hygiene and contamination remain understudied. This study aims to present a practical protocol for CPAP disassembly and cleaning and to report the outcomes of its implementation over a 2-year period. We conducted a retrospective chart review of 359 OSA patients prescribed CPAP therapy between 2018 and 2025. Of these, 136 patients participated in a complimentary, comprehensive CPAP cleaning service. Contamination was assessed using a subjective visual analog scale (VAS) following photographic documentation of each device component. The relationship between contamination scores and device usage duration was analyzed. Patients who received the cleaning service did not differ significantly from the overall cohort in terms of age, sex, apnea-hypopnea index, or average daily usage time, except that they had a significantly shorter total duration of usage. Contamination was found on all device components, including internal parts that are not routinely inspected. Positive correlations between contamination levels and usage duration were statistically significant for every component. The cleaning process required approximately 2 days per device and was feasible for routine clinical implementation. CPAP devices accumulate visible contamination over time, emphasizing the need for standardized cleaning protocols. Our experience indicates that physician-led education, patient cooperation, and dedicated involvement of paramedical staff are essential in reducing contamination risks. Interdisciplinary collaboration is recommended to develop evidence-based guidelines for CPAP hygiene management.

Continuous positive airway pressure (CPAP) is considered the gold standard treatment of obstructive sleep apnea (OSA). However, it can be a challenge in some patients to find an effective CPAP setting that is well tolerated. A lower CPAP setting may improve patient tolerance of the treatment. The objective of this study was to evaluate the effect of approximately 30° torso elevation on minimum effective CPAP for the treatment of OSA. A retrospective chart review was performed to determine the effective CPAP setting required to treat OSA in patients who underwent CPAP titration with torso elevation using a wedge cushion, after having failed during the same titration study to achieve therapeutic results at CPAP of 20cm H2O without torso elevation. Thirty-nine patients who underwent CPAP titration with and without torso elevation utilizing a wedge cushion had statistically significant lowering of the minimum effective CPAP setting with torso elevation, with a mean CPAP reduction of 4.7 (p< 0.001) compared to ineffective treatment at CPAP of 20cm H2O without torso elevation. Apnea hypopnea index (AHI), respiratory disturbance index (RDI), and lowest oxygen saturation (SpO2) were all improved with torso elevation, with a mean AHI difference of 4.4 (p= 0.03), mean RDI difference of 14.2 (p= 0.001), and mean SpO2 difference of 5.9% (p= 0.002). Age and BMI were inversely correlated, and gender had no correlation with therapeutic CPAP settings with use of torso elevation. Torso elevation of approximately 30° resulted in effective CPAP treatment at settings significantly lower than 20cm H2O in all reviewed OSA patients, who had been ineffectively treated without torso elevation at the maximum tested setting of 20cm H2O. This intervention may be a useful adjunct during in-lab titration studies for patients who are not effectively treated at or cannot tolerate high CPAP settings.

To evaluate the feasibility and efficacy of continuous positive airway pressure delivered by a new pediatric helmet in comparison with a standard facial mask in infants with acute hypoxemic respiratory failure. A single-center prospective case-control study. Pediatric intensive care unit in a tertiary children hospital. Twenty consecutive infants treated with continuous positive airway pressure by a helmet matched with a control patient treated with continuous positive airway pressure by facial mask and selected by age, weight, PaO2:Fio2, and PaCO2 on pediatric intensive care unit admission. Feasibility was defined as the incidence of continuous positive airway pressure protocol failure secondary to 1) failure to administer continuous positive airway pressure because of intolerance to the interface; 2) deterioration in gas exchange soon after continuous positive airway pressure institution; and 3) major clinical adverse events such as pneumothorax or any hemodynamic instability related to the continuous positive airway pressure safety system device's failure. Evaluation of feasibility included also the total application time of respiratory treatment, the number of continuous positive airway pressure discontinuations/first 24 hrs. Interface-related complications included air leaks, cutaneous pressure sores, eye irritation, inhalation, and gastric distension. The 20 patients and control subjects had similar matching characteristics. Continuous positive airway pressure delivered by a helmet compared with a facial mask reduced continuous positive airway pressure trial failure rate (p = .02), increased application time (p = .001) with less discontinuations (p = .001), and was not associated with an increased rate of major adverse events, resulting in decreased air leaks (p = .04) and pressure sores (p = .002). Both continuous positive airway pressure systems resulted in early and sustained improvement in oxygenation. The helmet might be considered a viable and safe alternative to a standard facial mask to deliver continuous positive airway pressure in hypoxemic infants in the pediatric intensive care unit setting. In our study, the helmet allowed more prolonged application of continuous positive airway pressure compared with a facial mask, ensuring similar improvement in oxygenation without any adverse events and clinical intolerance.

Background and ObjectivesFailure of continuous positive airway pressure (CPAP) in preterm infants may result from respiratory exhaustion, potentially also evoked by the CPAP device’s imposed work of breathing (iWOB). This study investigated in-vitro the iWOB of 16 CPAP-devices in four simulated neonatal scenarios with focus on the impact of different mechanisms of CPAP-generation.MethodsA neonatal lung model and 3D-printed nasopharyngeal dummies (representing a 1000 g preterm and a 3000 g term infant, settings: preterm/term: Vtid 4.5/14 ml, rate 80/60 bpm) were used to evaluate common CPAP-devices under various conditions (two levels of positive end-expiratory pressure: 5, 10 cmH2O).ResultsDuring 9300 simulated breaths, iWOB differed widely across investigated devices. The lowest inspiratory iWOB were observed in Bubble CPAP, variable-flow devices and constant-flow devices with turbine (0.04/0.15–0.17 mJ/breath for preterm/term model resp. 0.07/0.24–0.33 mJ/breath). Devices with mechanical regulation and with constant resistance require higher inspiratory effort and are therefore not relevant in the low iWOB group. The highest iWOB (0.41/2.92 mJ/breath at 5 cmH2O) was found in a T-piece device. The mechanism of CPAP generation influenced iWOB levels.ConclusionsThe magnitude of iWOB varied considerably between devices. This should be considered, to optimize non-invasive respiratory support in neonates.ImpactThis bench study detected differences in the imposed work of breathing (iWOB) between 16 different CPAP devices.In addition to existing literature, the present study contributes to a more comprehensive understanding of iWOB and the influence of CPAP generation due to the large number of CPAP devices investigated.If the identified differences are confirmed in clinical practice, this could streamline decision-making in CPAP device selection.

Black race has been associated with decreased continuous positive airway pressure (CPAP) adherence. Short sleep duration, long sleep latency, and insomnia complaints may affect CPAP adherence as they affect sleep and opportunity to use CPAP. We assessed whether self-reported sleep measures were associated with CPAP adherence and if racial variations in these sleep characteristics may explain racial differences in CPAP adherence. Analysis of data from a randomized controlled trial (HomePAP), which investigated home versus laboratory-based diagnosis and treatment of obstructive sleep apnea. Seven American Academy of Sleep Medicine-accredited sleep centers in five cities in the United States. Enrolled subjects (n = 191) with apnea-hypopnea index ≥ 15 and sleepiness (Epworth Sleepiness Scale > 12). N/A. Multivariable regression was used to assess if subjective sleep measures and symptoms predicted 3-mo CPAP use. Mediation analysis was used to assess if sleep measures mediated the association of race with CPAP adherence. Black participants reported shorter sleep duration and longer sleep latency at baseline than white and Hispanic participants. Shorter sleep duration and longer sleep latency predicted worse CPAP adherence. Sleep duration mediated the association of black race with lower CPAP adherence. However, insomnia symptoms were not associated with race or CPAP adherence. Among subjects with similar severity of obstructive sleep apnea and sleepiness, baseline self-reported sleep duration and latency, but not perceived insomnia, predicted CPAP adherence over 3 mo. Sleep duration explains some of the observed differences in CPAP use by race. Sleep duration and latency should be considered when evaluating poor CPAP adherence. PORTABLE MONITORING FOR DIAGNOSIS AND MANAGEMENT OF SLEEP APNEA (HOMEPAP) URL: http://clinicaltrials.gov/show/NCT00642486. NIH clinical trials registry number: NCT00642486.