SLEEP-DISORDERED BREATHING DIAGNOSIS AND TREATMENTkapak

Ümran Özden Sertçelik1,2 Emine Argüder3,4

1Ankara Yıldırım Bezyazıt University, Faculty of Medicine, Department of Chest Diseases, Ankara, Türkiye
2Ankara Bilkent City Hospital, Department of Chest Diseases, Ankara, Türkiye
3Ankara Yıldırım Bezyazıt University, Faculty of Medicine, Department of Chest Diseases, Ankara, Türkiye
4Ankara Bilkent City Hospital, Department of Chest Diseases, Ankara, Türkiye

Özden Sertçelik Ü, Argüder E. Positive Airway Pressure Therapies in Obstructive Sleep Apnea Syndrome. In: Özcan KM, editor. Sleep-Disordered Breathing: Diagnosis and Treatment. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.119-127.

ABSTRACT

Obstructive Sleep Apnea Syndrome (OSAS) is a common sleep disorder characterized by recurrent upper airway obstruction during sleep, which may lead to significant cardiovascular and neurocognitive complications. The most frequent symptoms include loud snoring, excessive daytime sleepiness, fatigue, and sleep fragmentation. Positive Airway Pressure (PAP) therapy is considered the first-line treatment for OSAS, shown to be effective in diminishing symptoms, enhancing quality of life, and preventing long-term complications. PAP devices deliver pressurized air to keep the upper airway open, using either fixed or variable pressure modes. The most basic device, Continuous Positive Airway Pressure (CPAP), provides a continuous fixed pressure, while APAP adjusts pressure automatically in response to respiratory events. Bi-level Positive Airway Pressure (BPAP) offers different pressure levels during inspiration (IPAP) and expiration (EPAP), facilitating breathing in patients who cannot tolerate fixed pressure. Advanced modes such as BPAP Spontaneous-Timed (BPAP-ST), Average Volume Assured Pressure Support (AVAPS), and Adaptive Servo-Ventilation (ASV) are used in complex cases involving central apnea, hypoventilation syndromes, or neuromuscular diseases. PAP therapy is effective only when consistently used, making patient compliance a critical factor in treatment success. To enhance adherence, careful adjustment of mask type, device settings, humidification, and comfort features is necessary. For optimal therapeutic effect, it is recommended that patients use the device for at least 4 hours per night and more than 70% of sleep times. Modern PAP devices are equipped with digital monitoring systems that record usage data, allowing healthcare providers to remotely monitor therapy and make data-driven adjustments. Additionally, smartphone integration facilitates real-time tracking and patient engagement. Beyond symptomatic relief, PAP therapy can positively influence the course of comorbid conditions such as hypertension, heart failure, and stroke. However, the effectiveness of treatment is closely linked to early patient education, appropriate device and mode selection, prompt management of side effects, and regular clinical follow-up.

Keywords: Obstructive sleep apnea syndrome; Positive airway pressure; Apnea

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