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CPAP, Bilevel, APAP, High and Low Loop Gain Syndromes

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Abstract

Positive airway pressure therapy is a core skill in sleep medicine and laboratory practice. This area has seen significant changes since the first edition of the Atlas, including the following: (1) availability and increased familiarity with use and limitations of adaptive ventilation and average/intelligent volume assured pressure ventilation [1–3], (2) the recognition of high loop gain apnea (complex sleep apnea) through morphological and computational analysis of polysomnograms [4–9], (3) demonstrated investigative and clinical efficacy of low-concentration carbon dioxide (CO2) and acetazolamide as positive airway pressure adjuncts [10–15], (4) changes in the pressure profile delivered by clinical devices that attempt to maximize comfort and improve synchrony between the patient and the ventilator, (5) formal guidelines for titration of positive airway pressure and noninvasive ventilation from the American Academy of Sleep Medicine (AASM) [16], which, however, have not been updated as of 2023, and (6) formal recommendations for polysomnography in noninvasive ventilation practice from the SomnoNIV group [17–19]. This chapter will aim to provide complementary information using informative snapshots. Slightly edited summaries of the AASM guidelines are provided below as a starting point, supplemented by discussions of adaptive ventilation, volume assured ventilation, use of dead space, supplemental oxygen, pharmacological protocols, and opiate-induced sleep-disordered breathing.

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Authors and Affiliations

  1. Division of Pulmonary, Critical Care and Sleep, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA

    Robert J. Thomas

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Editors and Affiliations

  1. Beth Israel Deaconess Medical Center, Boston, MA, USA

    Robert J. Thomas

  2. JFK Neuroscience Institute, Hackensack Meridian Health-JFK University Medical Center, Edison, NJ, USA

    Sushanth Bhat

  3. HMH JFK University Medical Center and Neuroscience Institute, Hackensack Meridian School of Medicine at Seton Hall University, South Orange and Nutley, NJ, USA

    Sudhansu Chokroverty

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Thomas, R.J. (2023). CPAP, Bilevel, APAP, High and Low Loop Gain Syndromes. In: Thomas, R.J., Bhat, S., Chokroverty, S. (eds) Atlas of Sleep Medicine. Springer, Cham. https://doi.org/10.1007/978-3-031-34625-5_32

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  • DOI: https://doi.org/10.1007/978-3-031-34625-5_32

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