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Posted by terrym on November 15, 2002 at 06:05:47:In Reply to: Re: Need some BiPAP/CPAP expertise posted by original poster on November 14, 2002 at 12:17:17:
Original poster;
it was a good question you raised. Unfortunately,
while there is no lack of opinions on how to titrate CPAP/BiLevel PAP, there is a lack of systematic studies demonstrating the effectiveness of one method over another.
So there is not a lot of reference material to point to. Sleep Medicine Pearls by R. Berry has several good examples of how to titrate both CPAP and Bilevel. (that book is on the BRPT suggested reading list) A new book published this year is Breathing Disorders in Sleep by McNicholas and Phillipson from WB Saunders. It has good info on a range of disorders and treatment, including titration.
As for the Central apneas; Dr White has a good chapter on these in Principles and Practices.
The sleep-onset centrals may be worse in the sleep lab since we usually have the patient sleep supine, which will increase the likelyhood of them, according to Dr White. I don't know of any study that has looked at Central apneas related to CPAP. In the above mentioned text, Breathing Disorders in Sleep, Dr Bradley, Toronto,Canada, says this; "Several reflexes have been described in animals and humans that are capable of triggering transient abolition of central resp drive. Perhaps the best known of these is the Hering-Breuer pulmonary inflation reflex. However, from a clinical standpoint, inhibitory reflexes arising in the upper airway are probably more important as potential mechanisms underlying CSA." Hope this is helpful; I learned from it.
thanks. tm :)
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