Johnson Karin G
Department of Neurology- Baystate Medical Center, University of Massachusetts Medical School-Baystate, Springfield, MA, USA.
Adv Exp Med Biol. 2022;1384:297-330. doi: 10.1007/978-3-031-06413-5_18.
Positive airway pressure (PAP) is the primary treatment of sleep-disordered breathing including obstructive sleep apnea, central sleep apnea, and sleep-related hypoventilation. Just as clinicians use pharmacological mechanism of action and pharmacokinetic data to optimize medication therapy for an individual, understanding how PAP works and choosing the right mode and device are critical to optimizing therapy in an individual patient. The first section of this chapter will describe the technology inside PAP devices that is essential for understanding the algorithms used to control the airflow and pressure. The second section will review how different comfort settings including ramp and expiratory pressure relief and modes of PAP therapy including continuous positive airway pressure (CPAP), autotitrating CPAP, bilevel positive airway pressure, adaptive servoventilation, and volume-assured pressure support control the airflow and pressure. Proprietary algorithms from several different manufacturers are described. This chapter derives its descriptions of algorithms from multiple sources including literature review, manufacture publications and websites, patents, and peer-reviewed device comparisons and from personal communication with manufacturer representatives. Clinical considerations related to the technological aspects of the different algorithms and features will be reviewed.
气道正压通气（PAP）是治疗睡眠呼吸障碍的主要方法，包括阻塞性睡眠呼吸暂停、中枢性睡眠呼吸暂停和睡眠相关通气不足。正如临床医生利用药物作用机制和药代动力学数据来优化个体药物治疗一样，了解PAP的工作原理并选择合适的模式和设备对于优化个体患者的治疗至关重要。本章的第一部分将描述PAP设备内部的技术，这对于理解用于控制气流和压力的算法至关重要。第二部分将回顾不同的舒适设置，包括斜坡和呼气压力释放，以及PAP治疗模式，包括持续气道正压通气（CPAP）、自动调压CPAP、双水平气道正压通气、适应性伺服通气和容量保证压力支持，如何控制气流和压力。文中描述了几家不同制造商的专有算法。本章对算法的描述来源于多个渠道，包括文献综述、制造商出版物和网站、专利、同行评审的设备比较，以及与制造商代表的个人交流。还将回顾与不同算法和功能的技术方面相关的临床考量。
