Continuous Positive Air Pressure (CPAP)

1
Continuous Positive Air Pressure(CPAP)

• Laeeq Ahmed
• Engr 296Y Summer 2006

2
Overview

• Introduction
• Potential Market
• Pathophysiology of OSA
• Regulatory Aspects
• Clinical Trial
• Future Direction
• Conclusion

3
Introduction

• Most of us take a good night sleep for granted.
• Obstructive sleep apnea is a sleep disorder in
  which a person repeatedly stops breathing or
  experiences shallow breathing for short periods
  of time during sleep.
• CPAP is used to keep airway open by providing
  steady stream of air.

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Types Of Sleep Apnea

• Central Sleep Apnea
• During sleep brain does not signal the chest and
  breathing stop
• Obstructive Sleep Apnea (OSA)
• During sleep air blocked from entering lungs
  because of upper airway collapses.
• Mixed Sleep Apnea
• Brain fails to trigger breathing and upper
  airway collapses at the same time

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Potential Market

• In the United States, 10 of adult population has
  interruption in normal breathing during their
  sleep.
• Larger number of patients under 30 Years of age
• Study shows 34 among line man in Football game
  has this disease
• Annual cost of Lost Productivity 18 Billion in
  USA

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Pathophysiology of OSA

• Sites of Obstruction

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Pathophysiology of OSA

• Findings in Obstruction
• Nasal Obstruction
• Long, thick soft palate
• Narrowed oropharynx
• Redundant pharyngeal tissues
• Large lingual tonsil
• Large tongue
• Large or floppy Epiglottis

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Pathophysiology of OSA

• Symptoms of OSA
• Snoring (most commonly noted complaint)
• Daytime Sleepiness
• Hypertension and Cardiovascular Disease are
  Associated
• Pulmonary Disease

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Pathophysiology of OSA

• Sites of Obstruction

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Pathophysiology of OSA
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Treatment Of OSA

• Medical Management
• Weight Loss
• Alcohol Avoidance
• Discontinuance of sleep medication
• Non surgical Management
• Continuous Positive Airway Pressure
• Oral Appliances
• Surgical Management
• Tracheostomy

12
Regulatory Aspect

• FDA Classification Class II
• CFR Section 868.5905
• Electrical and Mechanical safety standards are
  applicable
• Use in home or clinical environment

13
Regulatory Aspects

• Polysomnography
• Electromyography
• (measure muscle strength)
• Airflow
• EEG
• Oxygen Saturation
• Cardiac Rhythm
• Leg Movements

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CPAP Titration Rule

• Mild OSA, increased pressure 1cm/10 min until
  problem resolved or 6cm
• Moderate OSA, increased pressure 1cm/5min until
  problem resolved
• Severe OSA, increased pressure 2cm /5min until
  problem resolved

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CPAP
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CPAP
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CPAP Description

• Pressure is produced by spinning a reverse-curved
  impeller with a DC motor which pressurized
  blower.
• Maintain Pressure 5-15cm H20 to open up the
  airway
• Dual-Pressure blower
• Operates at 12 Volts DC
• The pressure titrated according to
  Polysomnography results.
• Provide supplemental oxygen to increase Oxygen
  level in blood
• Humidified air used to relieve dryness of
  compressed air.

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CPAP Specifications

• Operating Period - 12 hours at 10 cm H2o, 10
  hours at 12 cm H2o
• Dimension (W x H x L) - 14 x 12 x 4 inches (35.6
  x 30.5 x 10 cm)
• Operating altitude - 0 to approximately 6000 ft
  (0-1830 m)
• Battery Charger - Input Voltage 100-240 VAC (
  10),
• 50/60 Hz ( 1 Hz)
• Power Supply - 8 Cell Lithium-Ion Battery
• (Only use BreatheX supplied charger)

19
Clinical Trial

• During the study, 100 participants use a CPAP
  device for six months. Half receive active CPAP
  and half use a sham system. The researchers
  assess patients sleepiness, mood, quality of
  life and ability to think over the course of the
  study.
• Participation lasts seven months and includes two
  training session, several overnight sleep
  studies, three days of testing and two physician
  appointments. Participants receive 500 upon
  conclusion of the study.

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CPAP - Future direction

• Track hourly record and produced data on line
• Online calibration/titration
• Able to download data on computer and store it to
  data card.

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Automatic CPAP

• Auto titrating
• Sense pressure automatically
• Titrates CPAP with each breath
• Easy to operate

22
Non surgical Management

• Oral appliance
• Fitted by Dentist
• Tongue retaining device keeps the tongue in place
  while you sleep, so that it does not fall back
  and block the airway
• Not effective as CPAP

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Conclusion

• Drastic effect on Sleep Apnea
• Reducing Daytime blood pressure after period of
  treatment
• Expeditious Treatment
• Cost Saving
• Patient and family education is required.

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References

• Young T, Peppard PE.Epidemiology of obstructive
  sleep apnea. Am J respir Crit Care Med
  20021651200-75
• Friedman M, Ibrahim H, Bass L. Clinical staging
  for sleep-disordered breathing. Otolaryngol Head
  Neck Surg 2002
• Lieberman JA III. Treatment of patients with
  obstructive sleep apnea. Am Fam Physician 2005
• Sleep apnea. Accessed online November7,2005, at
  http//www.familydoctor.org