Automatic control of airway pressure for treatment of obstructive sleep apnea

Obstructive sleep apnea (OSA) occurs when airflow ceases because of pharyngeal wall collapse in sleep. Repeated apneic events results in the development of a pathological condition called OSA syndrome. The authors describe the methodology and design of a prosthetic device, named automatic positive airway pressure (APAP), for treatment of this syndrome. HPAP applies a stream of air via a nasal mask at an initial pressure selected by the patient. By sensing specific pressure characteristics of air flow immediately preceding pharyngeal wall collapse, the APAP device automatically raises the applied pressure to maintain a patent upper airway and thus prevent apnea. Conversely, when such conditions are absent, pressure is lowered step wise until a preselected minimum pressure is reached. Performance evaluation of the APAP system in five OSA patients and five normal (asymptomatic for sleep apnea) subjects revealed that it effectively treated OSA syndrome. It lowered the apnea-hypopnea index without disturbing sleep and resulted in a lower mean airway pressure compared to the traditional continuous positive airway pressure (CPAP) therapy. The results also show that the pressure needed to prevent OSA varied significantly throughout the night. For OSA syndrome patients, this pressure ranged from 3 to 18 cm H ₂O. The mean airway pressure for these patients had a sample average of 6.80 cm H ₂O and a standard deviation of 3.17 cm H ₂O. In normal subjects, the device did not raise pressure except in response to pharyngeal wall vibration events.