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Proportional positive airway pressure: a new concept to treat obstructive sleep apnoea

¹ Klinik für Schlafstörungen, Bayerisch Gmain, Germany. ² Zentrum für Innere Medizin, Philipps-Universität, Schlafmedizinisches Labor, Marburg, Germany

CORRESPONDENCE: J. Juhász, Klinik für Schlafstörungen, Reichenhaller Str. 20, 83457, Bayerisch Gmain, Germany. Fax: 49 8651770105

Keywords: continuous positive airway pressure, proportional positive airway pressure, sleep apnoea, sleep stages

Received: October 14, 1999
Accepted September 15, 2000

This study was supported by a research grant from Respironics Inc., Murrysville, USA.

Proportional positive airway pressure (PPAP) was designed to optimize airway pressure for the therapy of obstructive sleep apnoea (OSA). In a randomized crossover prospective study, the clinical feasibility of PPAP and its immediate effects on the breathing disorder and sleep in comparison with continuous positive airway pressure (CPAP) was evaluated. Twelve patients requiring CPAP therapy underwent CPAP and PPAP titration in a random order.

Obstructive and mixed respiratory events could be completely abolished with both forms of treatment. This efficacy could be achieved at a significantly lower mean mask pressure during PPAP titration (8.45±2.42 cmH₂O) compared to CPAP (9.96±2.7 cmH₂O) (p=0.002). The mean minimal arterial oxygen saturation (S_a,O2) (82.8±6.5%) on the diagnostic night increased significantly (p<0.001) to an average S_a,O2 of 93.35±1.71% and 93.19±2.9% during CPAP and PPAP titration. Total sleep time, slow wave sleep and rapid eye movement (REM) sleep increased significantly by the same amount during both CPAP and PPAP titration (p<0.001), while sleep stage nonrapid eye movement (NREM) 1 and 2 decreased. Six patients preferred the PPAP titration night, four patients did not have a preference, and two patients preferred CPAP.

The present data show that proportional positive airway pressure is as effective as continuous positive airway pressure in eliminating obstructive events and has the same immediate effect on sleep. The lower average mask pressure during proportional positive airway pressure implies potential advantages compared to continuous positive airway pressure. Proportional positive airway pressure presents a new effective therapeutic approach to obstructive sleep apnoea.

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