Pulmonary and Critical Care Division, Center for Sleep Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
Neurotherapeutics. 2021 Jan;18(1):81-90. doi: 10.1007/s13311-020-00955-x. Epub 2020 Nov 4.
Three decades ago, continuous positive airway pressure (CPAP) was introduced to treat obstructive sleep apnea (OSA). Shortly after, bilevel positive airway pressure devices (BPAP) that independently adjusted inspiratory and expiratory positive airway pressure were developed to treat complex sleep-related breathing disorders unresponsive to CPAP. Based on the bilevel positive airway pressure platform (hardware) governed by propriety algorithms (software), advanced modes of noninvasive ventilation (NIV) were developed to address complex cardiorespiratory pathophysiology beyond OSA. This review summarizes key aspects of different bilevel PAP therapies (BPAP with/without backup rate, adaptive servoventilation, and volume-assured pressure support) to treat common sleep-related hypoventilation disorders, treatment-emergent central sleep apnea, and central sleep apnea syndromes.
三十年前,持续气道正压通气(CPAP)被引入以治疗阻塞性睡眠呼吸暂停(OSA)。此后不久,开发了双水平气道正压通气装置(BPAP),该装置可独立调节吸气和呼气气道正压,以治疗对 CPAP 无反应的复杂睡眠相关呼吸障碍。基于受专有算法(软件)控制的双水平气道正压通气平台(硬件),开发了先进的无创通气(NIV)模式,以解决除 OSA 以外的复杂心肺病理生理学问题。本文综述了不同的双水平 PAP 治疗方法(带/不带备用频率的 BPAP、适应性伺服通气和容量保证压力支持)的关键方面,以治疗常见的睡眠相关低通气障碍、治疗中出现的中枢性睡眠呼吸暂停和中枢性睡眠呼吸暂停综合征。