Friday, April 18, 2014

Happy Birthday to CPAP!!!

Almost exactly 33 years after the publication of his pioneering paper on positive airway pressure for sleep apnoea (PAP) in The Lancet, Colin Sullivan continues to extend the boundaries of sleep medicine. In those three decades, PAP has gone from an obscure treatment available to few to an effective, portable treatment that has improved the sleep, and thus lifestyles, of millions worldwide.

Sullivan and his team undertook experiments with dogs on airway obstruction, and created a mask for use on human patients. Air pressure was controlled with a circuit that raised pressure until passive obstruction of the airway was cleared. His first test patient was a 43-year-old construction worker who did not want a tracheostomy—back then the only treatment. At very low pressures, PAP cleared the man's airway and allowed him to sink into a deeper sleep, as well as being sleep-free the next day. An elated Sullivan tried the technique on four other patients, and these findings formed the basis for his 1981 Lancet paper: Reversal of obstructive sleep apnoea by continuous positive airway pressure applied through the nares.

“When we were writing the paper,” says Dr. Sullivan, “we had no idea how many people had sleep apnea”.

Abstract from this great article: Five patients with severe obstructive sleep apnoea were treated with continuous positive airway pressure (CPAP) applied via a comfortable nose mask through the nares. Low levels of pressure (range 4·5-10 cm H2O) completely prevented upper airway occlusion during sleep in each patient and allowed an entire night of uninterrupted sleep. Continuous positive airway pressure applied in this manner provides a pneumatic splint for the nasopharyngeal airway and is a safe, simple treatment for the obstructive sleep apnoea syndrome.

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