RESEARCH: CPAP and Bi-PAP Work for Sleep Apnea!

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Rinsho Shinkeigaku 1998 Dec;38(12):1059-63

[Effective nasal CPAP therapy for heavy snoring and paradoxical respiration

during sleep in a case of multiple system atrophy]

Miyamoto M, Miyamoto T, Katayama S, Hirata K.

Department of Neurology, Dokkyo University School of Medicine, Tochigi,

Japan.

A 64-year-old man with multiple system atrophy complained of daytime

sleepiness,

fatigue, and snoring. Neurological examination revealed severe autonomic

failure, mild cerebellar ataxia and akinesia. Daytime blood gas analysis

showed

respiratory acidosis with hypoxia and hypercapnia. MR imaging of the brain

showed atrophy of the pons, cerebellum and bilateral frontal lobes. Although

paralysis of the vocal cord abduction was not found by laryngoscopy during

daytime examination, polysomnography (PSG) showed heavy snoring with

paradoxical

respiration associated with severe desaturation during sleep as well as

reduced

slow wave sleep and REM sleep. He was diagnosed as having sleep-related

upper

airway obstructive breathing disorder probably due to Gerhardt syndrome.

Tracheostomy was considered, but we performed nasal CPAP therapy during

sleep

because this therapy is non-invasive and would not impair his daily life.

After

nasal CPAP therapy, daytime sleepiness, fatigue, and snoring with

desaturation

improved, and PSG showed increased slow wave sleep. These results

demonstrate

that nasal CPAP therapy improves the quality of sleep and should be

considered

in patients with early stages of multiple system atrophy who exhibit

sleep-related breathing disorders.

PMID: 10349349

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Rinsho Shinkeigaku 1997 Jun;37(6):492-6

[Efficacy of nasal bi-level positive airway pressure ventilation in a

patient

with olivo-ponto-cerebellar atrophy suffering from sleep apnea syndrome]

Iijima M, Ota K, Ubano M, Kikuchi M, Iwata M.

Department of Neurology, Neurological Institute, Tokyo Women's Medical

College.

Sleep apnea with neuromuscular disorders has been successfully treated with

bi-level positive airway pressure ventilation (BiPAP), which, unlike

continuous

positive airway pressure ventilation (CPAP), creates pressure difference

between

expiratory and inspiratory phases. Hence if the respiration of patients

stops

longer than a pre-set duration, BiPAP can automatically force them to breath

through a nasal mask. We report a 60-year-old woman with

olivo-ponto-cerebellar

atrophy (OPCA), whose mixed-type sleep apnea was difficult to treat with

conventional CPAP. We therefore tried BiPAP on this patient at night.

Nocturnal

CO2 retention was nearly resolved, and unexpectedly daytime PaCO2 was also

corrected with marked improvement of daytime somnolence. BiPAP is totally

non-invasive, and may be one of the most effective treatments in patients

with

OPCA suffering from sleep apnea.

PMID: 9366176