Is Bi-level Positive Airway Pressure (BiPAP) used for Obstructive Sleep Apnea (OSA)?

From the Guidelines

BiPAP should not be used as the first-line treatment for sleep apnea, but rather considered for patients who cannot tolerate CPAP therapy or have specific conditions that require higher pressure settings, as stated in the American Academy of Sleep Medicine clinical practice guideline 1. When considering the treatment of sleep apnea, the primary goal is to improve morbidity, mortality, and quality of life. The use of BiPAP (Bilevel Positive Airway Pressure) is an option, but it is not the preferred initial treatment. According to the guideline, the majority of well-informed adult patients with obstructive sleep apnea (OSA) would prefer initiation of treatment with CPAP (Continuous Positive Airway Pressure) or APAP (Automatic Positive Airway Pressure) over BiPAP 1.

The benefits of BiPAP over CPAP or APAP are similar, but the low quality of evidence and potential harms or burdens do not favor the regular use of BiPAP for the routine treatment of OSA 1. However, there are specific situations where BiPAP may be necessary, such as for patients who require PAP treatment with pressures higher than 20 cm H2O, which CPAP units are not typically capable of delivering 1. Additionally, BiPAP may be considered for patients who are unable to tolerate CPAP or APAP due to high pressure requirements and despite the use of modified pressure profiles 1.

It's essential to note that the treatment of sleep apnea should be individualized, and the decision to use BiPAP should be based on a thorough evaluation of the patient's specific needs and conditions. The American Academy of Sleep Medicine clinical practice guideline recommends that clinicians use positive airway pressure, compared to no therapy, to treat OSA in adults with excessive sleepiness, with a strong recommendation 1.

In terms of specific settings, the typical starting settings for BiPAP might be 8-10 cmH2O for inhalation pressure and 4-6 cmH2O for exhalation pressure, though these are always individually adjusted by a sleep specialist. BiPAP requires a prescription and proper setup by a healthcare provider, including mask fitting and pressure calibration based on sleep study results. The device works by keeping the airway open throughout the night, preventing the pauses in breathing characteristic of sleep apnea, which improves oxygen levels, reduces daytime sleepiness, and lowers the risk of complications like high blood pressure and heart problems.

Key points to consider when using BiPAP for sleep apnea include:

• BiPAP is not the first-line treatment for sleep apnea
• BiPAP may be considered for patients who cannot tolerate CPAP therapy or have specific conditions that require higher pressure settings
• The decision to use BiPAP should be based on a thorough evaluation of the patient's specific needs and conditions
• BiPAP requires a prescription and proper setup by a healthcare provider
• The device works by keeping the airway open throughout the night, preventing the pauses in breathing characteristic of sleep apnea.

From the Research

Use of BiPAP for Sleep Apnea

• BiPAP (Bilevel Positive Airway Pressure) is a treatment option for obstructive sleep apnea (OSA) that can be used in place of or in addition to CPAP (Continuous Positive Airway Pressure) 2, 3.
• BiPAP can help to reduce the pressure required to keep the airway open, making it a more comfortable option for some patients 4.
• Studies have shown that switching from CPAP to BiPAP can improve sleep quality, reduce side effects, and increase patient satisfaction 4.

Benefits of BiPAP

• BiPAP can provide expiratory pressure relief, which can help to reduce the discomfort associated with CPAP 3, 4.
• BiPAP can also help to improve ventilation, which can be beneficial for patients with associated hypoventilation, such as those with chronic obstructive pulmonary disease (COPD) or severe obesity 2.
• BiPAP has been shown to be effective in reducing the apnea-hypopnea index (AHI) and improving sleep quality in patients with OSA 4, 5.

Comparison to Other Treatments

• CPAP is currently the recommended treatment for OSA, but BiPAP and other alternative treatments, such as mandibular advancement devices (MADs) and hypoglossal nerve stimulation (HNS), are being increasingly used 5, 6.
• Weight loss and lifestyle modifications are also important components of OSA treatment, particularly for patients who are overweight or obese 5, 6.
• The choice of treatment will depend on the individual patient's needs and preferences, as well as the severity of their OSA 5, 6.