From the Guidelines
VAP in sleep apnea refers to Variable Positive Airway Pressure, a type of PAP (Positive Airway Pressure) therapy used to treat sleep apnea, as recently supported by the European Respiratory Society guideline on non-CPAP therapies for obstructive sleep apnoea 1. This technology includes BiPAP (Bi-level Positive Airway Pressure), which provides higher pressure during inhalation and lower pressure during exhalation, and APAP (Auto-adjusting Positive Airway Pressure), which automatically adjusts pressure based on detected airway resistance.
- VAP is particularly beneficial for patients who find constant pressure uncomfortable or who have varying pressure needs throughout the night.
- The therapy works by preventing airway collapse during sleep, which is the primary cause of sleep apnea episodes.
- Patients typically use a mask connected to a VAP machine, with pressure settings determined by a sleep specialist based on the severity of their condition and comfort needs.
- VAP therapy helps reduce daytime sleepiness, improve sleep quality, and decrease the health risks associated with untreated sleep apnea, ultimately improving morbidity, mortality, and quality of life. The provided evidence from studies 1 focuses on ventilator-associated pneumonia, which is not directly related to the question of VAP in sleep apnea, but the most recent and relevant study 1 provides guidance on non-CPAP therapies for obstructive sleep apnoea.
From the Research
Definition of VAP
- Ventilator-associated pneumonia (VAP) is one of the most frequent hospital-acquired infections occurring in intubated patients 2
- VAP is associated with higher mortality, morbidity, and costs, and is proposed as an indicator of quality of care 2
Pathophysiology of VAP
- The principal determinant of VAP development is the presence of the endotracheal tube (ETT) 2
- Contaminated oropharyngeal secretions pool over the ETT cuff and subsequently leak down to the lungs through a hydrostatic gradient 2
- Impairment of mucociliary motility and cough reflex cannot counterbalance with a proper clearance of secretions 2
- Biofilm develops on the inner ETT surface and acts as a reservoir for microorganism inoculum to the lungs 2
Relationship between Sleep Apnea and VAP
- There is no direct evidence in the provided studies that specifically links sleep apnea to VAP 3, 4, 5, 6
- However, studies suggest that sleep apnea may increase the risk of pneumonia, which can potentially lead to VAP in patients who require mechanical ventilation 4, 6
Incidence and Mortality of VAP
- The incidence of VAP ranges from 7 to 43 per thousand days, varying among different countries of the world 5
- A significant rate of mortality is observed in patients with VAP, ranging from 6.3 to 66.9% 5
- Gram-negative organisms like Acinetobacter spp., Pseudomonas aeruginosa, and Gram-positive organisms like Staphylococcus aureus are frequently found in patients with VAP 5