Analysis of CPAP Failures

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Introduction

Arguably, the goal of treatment of obstructive sleep apnea (OSA) is (1) elimination or improvement of symptoms, (2) normalization or improvement of sleep study parameters, and (3) cardiovascular risk reduction in the longer term. The latter is especially true for severe OSA or for mild to moderate OSA, starting at a younger age.

In 1981, continuous positive airway pressure (CPAP) was introduced as a treatment of OSA and has been considered the gold-standard treatment of severe OSA. It acts as a pneumatic splint, or for the cyclists among us, it inflates a flat tire ( Fig. 9.1A and B ).

It is a safe therapeutic option with few contraindications or serious side effects. Unfortunately many patients experience CPAP therapy as intrusive, and the acceptance and (long-term) compliance of CPAP are, at best, moderate. This chapter describes various reasons for CPAP failure and discusses the clinical implications.

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