Continuous positive airway pressure (CPAP) is a small machine that pumps a non-stop supply of compressed air through a mask which keeps the walls of the throat open. The mask may either cover the nose or the noseand mouth. The compressed air helps to stop the throat from closing. It is considered the most effective therapy for treating severe cases of obstructed sleep apnoea/hypopneasyndrome and must always be worn when sleeping.
Why is it used?
Everyone breathes in oxygen from the air to stay alive. The oxygen goes into the blood through the lungs. When the body has used the oxygen, it produces carbon dioxide which is breathed out. This is called ventilation.Some people with severe lung problems are unable to breathe in enough oxygen and breathe out carbon dioxide which can lead to the lungs not working properly.
Obstructive Sleep Apnoea Hypopnea Syndrome (OSAHS)
Obstructive Sleep Apnoea Hypopnea Syndrome (OSAHS) is a condition where the muscles supporting the walls of the throat relax and narrow during sleep. This affects normal breathing and causes the airflow to be blocked for a few seconds or more. At times, the airflow can stop completely. It may also wake you up from sleep several times so breathingc an return to normal.
Apnoea is where the walls of the throat relax and narrow, usually during sleep, which affects normal breathing. It causes the airflow to be blocked for 10 or more seconds.
This is a partial blockage of the airway that results in an airflow reduction of greater than 50% for 10 seconds or more.
In some patients, OSAHS can cause extreme daytime sleepiness, and affect daily life including not being able to sleep, eat, walk or drive on their own. The condition is also associated with ageing, obesity and high blood pressure, which increases the risk of heart disease and stroke.
Treatment for OSAHS aims to reduce daytime sleepiness by reducing the number of episodesof apnoea/hypopnoea experienced during sleep. CPAP is most commonly used to help manage moderate or severe sleep OSAHS.
Other treatments include lifestyle management such as losing weight, eating healthier, stopping smoking, decrease the amount of alcohol consumed and not taking sleep medicines.
The use of CPAP at home for OSAHS is restricted. Patients with moderate or severe symptomsof obstructive sleep apnoea hypopnoea syndrome must meet the following criteria to be approved:
- Severe inability to function properly during the day which is impacting on the patient’sability to carry out activities of daily living
- Lifestyle changes have not helped
- Other relevant treatment options have not worked or are considered unsuitable
- Have an Apnoea–Hypopnoea Index level between 15 to 30 or over.
This means (for patients who DO NOT meet the above criteria) the clinical commissioning group (CCG) will only fund the treatment if an Individual Funding Request(IFR) application proves clinical need and the CCG supports this.
Advice and further guidance:
- Read the evidence review
- For more information and advice visit www.nhs.uk
- Choosing Wisely UK is part of a global initiative aimed at improving conversations between patients and their doctors and nurses.
Treatment policy for patients covered by NHS Birmingham and Solihull CCG
- Download the leaflet
- Download the Policy for use of domiciliary continuous positive airway pressure (CPAP) devices.