What are acceptable driving pressures for Continuous Positive Airway Pressure (CPAP)?

From the Guidelines

Acceptable driving pressures for Continuous Positive Airway Pressure (CPAP) should be maintained within the recommended IPAP and EPAP settings, with a minimum starting IPAP of 8 cm H2O and EPAP of 4 cm H2O, and a maximum IPAP of 30 cm H2O for patients ≥ 12 years and 20 cm H2O for patients < 12 years. When adjusting CPAP settings, clinicians should consider the individual patient's needs and response to therapy, as well as the potential risks and benefits of different pressure settings 1. Key considerations include:

• Minimum starting IPAP and EPAP settings of 8 cm H2O and 4 cm H2O, respectively
• Maximum IPAP settings of 30 cm H2O for patients ≥ 12 years and 20 cm H2O for patients < 12 years
• Adjusting IPAP and EPAP settings to optimize patient comfort, adherence, and therapeutic efficacy The recommended pressure settings are based on the best clinical practices for the sleep center adjustment of noninvasive positive pressure ventilation (NPPV) in stable chronic alveolar hypoventilation syndromes, as outlined in the Journal of Clinical Sleep Medicine 1. By following these guidelines, clinicians can help ensure that patients receive effective and safe CPAP therapy, with the goal of improving morbidity, mortality, and quality of life outcomes. It is essential to monitor patient response to therapy and adjust CPAP settings as needed to optimize treatment outcomes, while minimizing the risk of adverse effects and complications 1.

From the Research

Acceptable Driving Pressures for Continuous Positive Airway Pressure (CPAP)

• The acceptable driving pressures for CPAP can vary depending on the individual patient and their specific needs 2, 3.
• Studies have shown that CPAP pressures can range from 5-15 cmH2O, with some patients requiring higher or lower pressures to effectively treat their obstructive sleep apnea (OSA) 2, 4.
• The American Academy of Sleep Medicine recommends that CPAP pressures be titrated to determine the optimal pressure for each patient, which can be done through full-night, attended polysomnography or split-night, diagnostic-titration studies 3.
• Bilevel positive airway pressure (BPAP) devices, which provide different pressures for inspiration and expiration, may be useful for patients who have difficulty tolerating CPAP or require higher pressures 5, 4.
• Factors such as breathing frequency, tidal volume, and system resistance can affect the effective nasal mask pressure, and CPAP machines may not maintain the set pressure dynamically under simulated clinical conditions 6.

Key Findings

• A study published in 2012 found that Auto bi-level Pressure Relief-Positive Airway Pressure (ABPR-PAP) was as effective as CPAP in treating OSA patients, with pressures ranging from 5-15 cmH2O 2.
• A 2014 review of BPAP therapy for OSA found that it may be useful for patients who are poorly compliant with CPAP or require higher pressures 5.
• A 2006 practice parameter for the use of CPAP and BPAP devices recommends that CPAP pressures be titrated to determine the optimal pressure for each patient, and that BPAP may be useful for patients with restrictive lung disease or hypoventilation syndromes 3.
• A 2023 study found that switching from CPAP to BPAP improved sleep quality and reduced side effects in patients with OSA, with median expiratory PAP pressures ranging from 8-9 cmH2O 4.
• A 2000 study found that CPAP machines may not maintain the set pressure dynamically under simulated clinical conditions, with pressure deviations ranging from 0.7-2.9 cmH2O below and 0.5-1.0 cmH2O above the set pressure 6.