Manual Titration of Positive Airway Pressure in Patients with Obstructive Sleep Apnea

Positive airway pressure (PAP) devices are used to treat patients who have sleep-related breathing disorders including obstructive sleep apnea. After a patient is diagnosed with obstructive sleep apnea, the current standard of practice involves performing attended polysomnography, during which positive airway pressure is adjusted throughout the recording period to determine the optimal pressure for maintaining upper airway patency. Continuous positive airway pressure (CPAP) and bilevel positive airway pressure (BPAP) represent the two most common forms of PAP that are titrated manually during polysomnography to determine the single fixed pressure of CPAP, or the fixed inspiratory and expiratory PAPs of BPAP for subsequent nightly usage in the home. I recently cochaired the PAP Titration Task Force of the American Academy of Sleep Medicine, which reviewed the available literature on PAP titration protocols and strategies and, based on this analysis and expert consensus, developed recommendations for conducting CPAP and BPAP titrations. This article serves to review the task force recommendations and to provide a practical approach to using selected recommendations in the course of laboratory titration of PAP

The circulation of the airways: anatomy, physiology and potential role in drug delivery to the respiratory tract

As the pricipal source of blood flow to the conducting airways, the airway circulation can influence the metabolism and clearance of biologically active, locally released substances, the distribution of systemically administered pharmacologic agents to the airway and the absorption of inhaled pharmacologic agents from the airway. There are some preliminary experimental data in humans and other species which support this notion. However, the literature pertaining to the role of the airway circulation in drug delivery, absorption and metabolism is sparse. Nevertheless, a brief review of the anatomical and physiological properties of the airway circulation implies an important role for the airway circulation in the delivery or absorption of pharmacologic agents within the conducting airways

Obstructive sleep apnea Treatment improves quality of life-and may prevent death

A group of women are talking about their husbands' sleep habits. Tossing, turning, snoring, and falling asleep in the easy chair right after dinner come up. Then someone says, "What really bothers me is when he quits breathing." Several other spouses agree. What they may not know is that this is sleep apnea, which can have serious consequences if left untreated. Drs Chua and Chediak discuss risk factors, causes, diagnosis, and treatment of obstructive sleep apnea