Preference for fixed or automatic CPAP in patients with obstructive sleep apnea syndrome

BACKGROUND: The aims of this study were to compare compliance to treatment with fixed CPAP and with autoCPAP, subjective preference for type of CPAP treatment, and factors associated to preference for autoCPAP in patients with OSAS. PATIENTS AND METHODS: Twenty-two subjects were studied in a randomized, single blind cross-over fashion. They were treated for one month by fixed CPAP (Elite Sullivan V, ResMed, Sydney, Australia) and one month by autoCPAP (Autoset T, ResMed, Sydney, Australia). RESULTS: Four subjects who stated a preference for fixed CPAP and four who expressed no preference were pooled together; fourteen preferred autoCPAP. Compliance to treatment using the two machines did not differ in the first group (3.8 (1.9) vs. 3.8 (1.5)h/day, fixed vs autoCPAP), but was higher with autoCPAP in the second group (4.8 (1.8) vs 5.5 (1.5)h/day, P<0.05). Baseline apnea/hypopnea index (AHI) was high in both groups, but was higher in the second group P<0.02. First treatment was always fixed CPAP in patients who preferred fixed CPAP, while it was either in the other subjects. CONCLUSIONS: Compliance to autoCPAP differs among OSAS patients. As long as factors predicting higher compliance to autoCPAP are not found, a trial with autoCPAP in patients poorly compliant to fixed CPAP may be warranted.     

Evaluation of autoCPAP devices in home treatment of sleep apnea/hypopnea syndrome

BACKGROUND AND PURPOSE: Quality of life (QOL) and sleepiness for patients with sleep apnea/hypopnea syndrome (SAHS) might improve with continuous positive airway pressure devices working in auto-adjust mode (autoCPAP) by allowing pressure modulations following patient needs. Clinical comparisons between devices driven by different algorithms are needed. METHODS: We compared the clinical effectiveness of fixed pressure CPAP and four different autoCPAP devices by assessing compliance and QOL (36-item short-form health survey [SF-36]). SAHS patients were randomly allocated to five groups. Polysomnography (PSG) was performed to titrate the effective pressure in the constant CPAP group and evaluate residual apnea/hypopnea index (AHI) under autoCPAP. Follow-up consisted of clinical visits at three and six months by homecare technicians who assessed compliance, symptom scores and SF-36 scores. A laboratory-based PSG using the same CPAP/autoCPAP device as at home was performed at six months. RESULTS: Eighty-three patients (mean age 56+/-10 yrs) with mean body mass index (BMI) 30.8+/-5.3 kg/m(2) and severe SAHS (mean AHI: 52.3+/-17.8/h) were included. There were no differences in clinical symptoms or QOL scores, and similar clinical and PSG improvements were seen in all groups. CPAP use was >5 h per night, without any significant difference between groups. CONCLUSIONS: AutoCPAP is equally as effective as fixed CPAP for long-term home treatment in severe SAHS patients.     

A prospective study of nocturia and the quality of life of elderly patients with obstructive sleep apnea or sleep onset insomnia

OBJECTIVE: To prospectively evaluate the relationship between obstructive sleep apnea syndrome (OSAS), nocturia and quality of life in elderly patients free of the urologic and medical conditions that lead to increased nocturia. METHODS: Prospective study of nocturia in men 65 years and older with isolated OSAS or sleep onset insomnia. After a 7-day nocturia evaluation and nocturnal polysomnography, Epworth Sleepiness Scale (ESS), Beck Depression Inventory (BDI), Quality of Life (SF-36) were administered. RESULTS: OSAS patients with frequent nocturia had significantly greater body mass index (BMI), greater apnea-hypopnea index (AHI), lower lowest oxygen saturation and lower SF-36 subscale scores. Treatment with nasal continuous positive airway pressure (CPAP) for OSAS and behavioral techniques for insomnia improved ESS and BDI scores for all three groups. SF-36 subscale scores improved more in subjects with multiple nocturia. AHI and BMI explain 38% of the variance for nocturia. CONCLUSION: Nasal CPAP reduces OSA and nocturia and improves quality of life of elderly patients.     

Pregnancy, sleep disordered breathing and treatment with nasal continuous positive airway pressure

OBJECTIVE: To investigate the tolerance, compliance and problems associated with usage of nasal continuous positive airway pressure (CPAP) by pregnant women with sleep disordered breathing (SDB). PATIENTS AND METHOD: Twelve pregnant women diagnosed with SDB received polysomnography (PSG) at entry, CPAP titration, repeat PSG at 6 months gestation (GA) and home monitoring of cardio-respiratory variables at 8 months GA. Compliance was verified by the pressure at the mask. Results from the Epworth sleepiness scale, fatigue scale and visual analogue scales (VAS) for sleepiness, fatigue, and snoring were compared over time. RESULTS: All of the subjects had full term pregnancies and healthy infants. Nightly compliance was at least 4 h initially and 6.5 h at 6 months GA. Nasal CPAP significantly improved all scales compared to entry. VAS scores remained lower at 6 months GA compared to entry. Re-adjustment of CPAP pressure was needed in six subjects at 6 months GA. CONCLUSION: Nasal CPAP is a safe and effective treatment of SDB during pregnancy.     

Improvement of subjective work performance among obstructive sleep apnea patients after treatment with continuous positive airway pressure

Obstructive sleep apnea syndrome (OSAS) is a significant problem for some patients presenting with snoring and excessive daytime sleepiness. The 'golden standard' therapy in OSAS is considered to be nasal continuous positive airway pressure (CPAP). The effects of CPAP on work performance in sleep apnoics has not been studied previously. One hundred and fifty-two patients with OSAS participated in an open label study. The patients were diagnosed as suffering from severe OSAS after they underwent overnight polysomnography showing that their apnea indexes were at least 20. The participants answered four questions concerning self-perceived work performance prior to and after using CPAP during 6 months. There were highly statistically significant decreases (P < 0.000001) in work performance difficulties as graded by the patient. The results of this study indicate that CPAP treatment improves subjective work performance in patients suffering from OSAS.     

持续气道正压通气治疗癫(痫)与阻塞性睡眠呼吸暂停综合征共病疗效的系统评价

目的 评价持续气道正压通气治疗癫(痫)与阻塞性睡眠呼吸暂停综合征共病的有效性.方法 以sleep apnoea、obstructive sleep apnoea、OSA、obstructive sleep apnoea syndrome、OSAS、sleepapnoea syndromes、sleep-related breathing disorder、epilepsy、continuous positive airway pressure、CPAP等英文词汇计算机检索1980年1月1日-2017年2月28日美国国立医学图书馆生物医学信息检索系统(PubMed)、荷兰医学文摘(EMBASE/SCOPUS)、Cochrane图书馆等数据库收录的关于持续气道正压通气治疗癫痼与阻塞性睡眠呼吸暂停综合征共病的随机对照临床试验、临床指南、系统评价(包括Meta分析)、病例对照研究、回顾性队列研究等.采用Jadad量表、Cochrane系统评价手册和RevMan 5.3统计软件进行文献质量评价和Meta分析.结果 共获得1197篇英文文献,经剔除重复和不符合纳入标准者,最终纳入17篇文献,包括临床指南1篇、系统评价和Meta分析各1篇、随机对照临床试验l篇、病例对照研究10篇、回顾性队列研究3篇.结果显示:(1)持续气道正压通气可以减少癫(痫)与阻塞性睡眠呼吸暂停综合征共病患者癫(痫)发作频率甚至无发作.(2)持续气道正压通气可以减少难治性癫(痫)与阻塞性睡眠呼吸暂停综合征共病患者癫(痫)发作频率.(3)持续气道正压通气可以减少老年癫(痫)与阻塞性睡眠呼吸暂停综合征共病患者癫(痫)发作频率.(4)对3项Jadad评分≥4分的临床研究共153例癫(痫)与阻塞性睡眠呼吸暂停综合征共病患者进行Meta分析,与未接受持续气道正压通气组相比,接受持续气道正压通气组癫(痫)发作频率减少＞50％的病例数增加(RR=3.170,95％ CI:1.650 ～ 6.090;P=0.001).结论 持续气道正压通气可以减少癫(痫)与阻塞性睡眠呼吸暂停综合征共病患者癫(痫)发作频率,其治疗效果取决于患者依从性,突然停止或压力不足可能导致癫痫发作频率增加,这一结论尚待更多随机对照临床试验证实.     

Outcome of sleepiness and fatigue scores in obstructive sleep apnea syndrome patients with and without restless legs syndrome after nasal CPAP

BACKGROUND & PURPOSE: The association of obstructive sleep apnea syndrome (OSAS) and restless legs syndrome (RLS) has been reported in the literature for many years. Both conditions may be responsible for fatigue and somnolence complaints secondary to nocturnal sleep disruption. The primary concern of this study is to evaluate the outcome of fatigue and daytime sleepiness symptoms at baseline and after continuous positive air pressure (CPAP) treatment in OSAS patients with and without RLS. METHOD: A prospective and comparative study between a group of 13 patients with OSAS and a group of 17 patients with OSAS+RLS. Laboratory blood tests and polysomnography were performed at baseline. The Epworth Sleepiness Scale (ESS) and the Pichots questionnaire of fatigue/depression (PIC) were applied before and after 3 months of CPAP treatment. Results were compared. RESULTS: No significant differences were found on PSG and laboratory results at baseline. Both groups had similar ESS and PIC scores at baseline (p=0.73 and 0.08, respectively). After n-CPAP, OSAS+RLS patients showed higher ESS and PIC scores (p=0.017 and 0.03, respectively). CONCLUSIONS: Despite a favorable general response, n-CPAP seemed less effective in treating fatigue and sleepiness in the OSAS+RLS group.     

Persistent sleepiness in CPAP treated obstructive sleep apnea patients: evaluation and treatment

Nasal continuous positive airway pressure (CPAP) is an effective treatment for most patients with obstructive sleep apnea syndrome (OSAS), improving sleepiness, cognitive function and mood. A number of patients, however, complain about persistent sleepiness after CPAP. In these cases another clinical history should be carried out to confirm the diagnosis of OSAS, to check CPAP compliance and to exclude associated conditions such as poor sleep hygiene, depression, narcolepsy or idiopathic hypersomnia. If necessary, a full polysomnography (PSG) followed by a multiple sleep latency test or even a full PSG with CPAP titration should be performed. Experimental data in animals suggest that long-term intermittent hypoxia related to the apneic events could deteriorate the brain structures that regulate alertness. This impairment, if present in humans, could be another reason for residual sleepiness after CPAP. Modafinil has been shown to reduce subjective sleepiness after CPAP in OSAS patients. Further studies are warranted to clarify the way in which CPAP modifies sleepiness.     

Sleep apnea: clinical investigations in humans

Sleep apnea syndrome (SAS), a common disorder, is characterized by repetitive episodes of cessation of breathing during sleep, resulting in hypoxemia and sleep disruption. The consequences of the abnormal breathing during sleep include daytime sleepiness, neurocognitive dysfunction, development of cardiovascular disorders, metabolic dysfunction, and impaired quality of life. There are two types of SAS: obstructive sleep apnea syndrome (OSAS) and central sleep apnea syndrome (CSAS). OSAS is a prevalent disorder in which there is snoring, repetitive apneic episodes, and daytime sleepiness. Anatomical conditions causing upper airway obstruction (obesity or craniofacial abnormalities such as retrognathia or micrognathia) can cause OSAS. CSAS, much less common than OSAS, is a disorder characterized by cessation of breathing which is caused by reduced respiratory drive from the central nervous system to the muscles of respiration. The latter condition is common in patients with heart failure and cerebral neurologic diseases. The diagnosis of SAS requires assessment of subjective symptoms and apneic episodes during sleep documented by polysomnography. Treatments of OSAS include continuous positive airway pressure (CPAP), oral appliances, and surgery; patients with CSAS are treated with oxygen, adaptive servo-ventilation, or CPAP. With assessment and treatment of the SAS, patients usually have resolution of their disabling symptoms, subsequently resulting in improved quality of life.     

Regular CPAP utilization reduces nasal inflammation assessed by nasal cytology in obstructive sleep apnea syndrome

ObjectivesTo analyze nasal inflammation in a group of patients with obstructive sleep apnea syndrome (OSAS) by means of nasal cytology and to describe the changes induced by continuous positive air pressure (CPAP) treatment.Subjects and methodsThirty-two consecutive patients affected by OSAS (mean age 46.9 years) and 13 control subjects (mean age 49.1 years) were enrolled. Detailed clinical, laboratory, and polysomnographic studies were obtained in all participants and, in particular, nasal cytology was performed; inflammatory cells (neutrophils, eosinophils, mast cells, lymphocytes), bacteria, and spores were counted. A subgroup of 19 OSAS patients underwent regular nasal CPAP for eight weeks while the remaining 13 were noncompliant. Nasal cytology was repeated after eight weeks in all patients and controls.ResultsAll patients with OSAS were affected by some form of rhinopathy, mostly subclinical, which was not found to influence compliance to CPAP. Regular CPAP treatment induced a significant reduction of cell infiltration (neutrophils, eosinophils, lymphocytes, and muciparous cells), which was not seen in nontreated patients.ConclusionNasal inflammation/infection is a very frequent finding in OSAS and can be reverted by the regular use of CPAP.     

Ultra-low-field magnetic resonance imaging in upper airways obstruction in sleep apnea syndrome

Abstract The hypothesis that the sites of upper airways obstruction (U AO) are varied in a patient with obstructive sleep apnea syndrome (OSAS) among different sleep stages is studied. Four patients with OSAS underwent ultra-low-field magnetic resonance imaging (MRI) with a field strength of 0.064 Tesla provided real-time images and generated less noise and necessitated less strict magnetic isolation compared with conventional high-field MRI. After the fixed end-apneic sleep stage was determined, the polysomnogram was switched off and ultra-low-field MRI was commenced. The effects of continuous positive airway pressure (CPAP) on the upper airway patency in the deepest sleep stage obtained for each patient was assessed. Upper airway obstruction was found at the level of the palatopharynx (PP) at sleep onset extended to the glossopharynx (GP) during rapid eye movement (REM) sleep in two cases and during NREM sleep in one case. This combined PP and GP obstruction was observed from sleep onset and remained unchanged in one case. The patent upper airways were observed during treatment with CPAP during REM sleep in two patients and during stage two of NREM sleep in the other two patients. It can be concluded that the sites of UAO vary in a patient with OSAS in different sleep stages. The results also suggest the use of the ultra-low-field MRI in order to visualize the dynamic and real-time behaviors of the upper airways during sleep in patients with OSAS.     

Continuous positive airway pressure for sleep-related breathing disorders in multiple system atrophy: long-term acceptance

BACKGROUND AND PURPOSE: To assess the long-term acceptance of non-invasive nasal continuous positive air pressure (CPAP) in multiple system atrophy (MSA) patients with polysomnographic (PSG)-confirmed sleep apneas and/or nocturnal stridor. PATIENTS AND METHODS: Sleep-related breathing disorders were investigated by PSG in 22 MSA patients in whom stridor and sleep-related respiratory disturbances were clinically suspected. Patients in whom the first PSG disclosed either a sleep apnea/hypopnea index (AHI)> or =10 or stridor with or without apneas underwent a second PSG for CPAP titration. RESULTS: Three patients presented with an obstructive sleep apnea syndrome without stridor, whereas 15 patients presented stridor occurring alone or accompanied by apneas. Twelve patients pursued CPAP. Two severely disabled patients died a few days after CPAP initiation, and five discontinued CPAP because of discomfort. One patient died after 17 months of follow-up. Since the onset of CPAP, the four remaining patients reported more efficacious sleep and improved daytime alertness. These patients had significantly less severe disease at the time of CPAP initiation. Age, disease duration, the presence of sleep complaints, excessive daytime somnolence (EDS) and AHI did not account for CPAP compliance. CONCLUSION: The severity of motor impairment at the initiation of treatment appears to be the most significant limiting factor for CPAP long-term acceptance.     

Does continuous positive airway pressure treatment affect autonomic nervous system in patients with severe obstructive sleep apnea?

ObjectiveThis study is aimed at evaluating whether Continuous Positive Airway Pressure treatment (CPAP) may affect autonomic nervous system (ANS) in male patients with severe obstructive sleep apnea (OSAS).MethodsWe compared autonomic symptoms of de novo severe OSAS patients, OSAS patients on chronic CPAP treatment and healthy controls, using the Scales for Outcome in Parkinson disease-Autonomic (SCOPA-AUT) questionnaire. All groups underwent cardiovascular function tests including head-up tilt test (HUTT), Valsalva maneuver, deep breathing, hand grip and cold face tests. Statistical significance was set at p < 0.05.ResultsTwelve de novo severe OSAS patients, 17 male OSAS on CPAP and 14 controls were studied. The mean SCOPA-AUT total score was significantly higher in de novo OSAS patients compared with controls. Regarding the distinct domains, both de novo OSAS and CPAP group had abnormalities in respect of controls in urinary sphere. In supine rest condition the baseline values of systolic blood pressure were significantly increased in untreated OSAS patients compared with controls, whereas the basal values of diastolic blood pressure were significantly higher in CPAP patients with respect to controls. After ten min of HUTT, diastolic blood pressure changes were significantly higher in controls compared to both OSAS groups. Untreated OSAS patients showed significant different responses at deep breathing compared to controls. Both OSAS groups had a significant reduction of reflex bradycardia at cold face test.ConclusionsOur study shows that both treated and untreated OSAS patients complain of subjective autonomic symptoms like other sleep disorders reinforcing the close relationship between sleep and autonomic activity. Furthermore, cardiovascular reflexes indicate a tendency to hypertension and a reduced sensitivity to stimuli during wakefulness even in OSA patients on CPAP treatment, suggesting potentially permanent autonomic function deficits.     

A pilot study evaluating acute use of eszopiclone in patients with mild to moderate obstructive sleep apnea syndrome

OBJECTIVE: To evaluate the effects of eszopiclone on measures of respiration and sleep using polysomnography in patients with mild to moderate obstructive sleep apnea syndrome (OSAS). METHODS: This double-blind, randomized crossover study included patients (35-64 years) with mild-to-moderate OSAS [apnea and hypopnea index (AHI) range 10 and 40]. Patients received either eszopiclone 3mg or placebo for two consecutive nights, with a 5-7 day washout between treatments. Continuous positive airway pressure (CPAP) was not allowed on nights in the sleep laboratory. RESULTS: The primary endpoint, mean total AHI, was not significantly different from placebo (16.5 with placebo and 16.7 with eszopiclone; 90% confidence interval (CI) -1.7, 1.9). No significant differences in total arousals, respiratory arousals, duration of apnea and hypopnea episodes, or oxygen saturation were noted. Significant differences in spontaneous arousals (13.6 versus 11.4 for placebo and eszopiclone, respectively; 90% CI -3.7, -0.7), sleep efficiency (85.1% and 88.4%; p=0.0075), wake time after sleep onset (61.8 and 48.1 min; p=0.0125), and wake time during sleep (55.9 and 43.2 min; p=0.013) were noted after eszopiclone treatment. Eszopiclone was well tolerated. CONCLUSIONS: In this pilot study, eszopiclone did not worsen AHI, and it improved sleep maintenance and efficiency. Further study is warranted to determine whether eszopiclone could improve CPAP compliance or next-day function in patients with OSAS.     

REM rebound and CPAP compliance

Objective/BackgroundThe objective of this study was establish if rapid-eye-movement (REM) rebound on first exposure to continuous positive airway pressure (CPAP) is associated with CPAP compliance. A rebound or drastic increase in REM sleep in response to initial CPAP exposure is associated with improvement in the subjective quality of sleep. We wished to determine if REM rebound was also associated with increased CPAP compliance.MethodsSplit night polysomnographic studies carried out in a one-and-a-half year period were examined for REM rebound and slow wave sleep (SWS) rebound. Compliance with CPAP according to percentage of days used and percentage of days used for more than 4 h was determined at 30, 60, and 120 days and compared between groups with and without REM rebound and then between groups with and without SWS rebound. Multivariate regression models were constructed to determine factors that were associated with increasing CPAP compliance.ResultsCPAP compliance was greater for those with REM rebound than those without REM rebound at all time periods, but significantly so only for total percentage of days used at 30 days (86.7 ± 46.7, 96.7 vs. 56.7 [median ± 1st quartile, 3rd quartile] ± 32.5, 90.0; p = 0.04) and 60 days (78.3 ± 37.5, 93.4 vs. 50.0 ± 25.0, 80.9; p = 0.03). There was no difference in CPAP compliance for SWS rebound and there were no SWS rebound groups. Only the presence of REM rebound was associated with increased compliance with CPAP with neither SWS rebound nor diagnostic AHI being significantly associated with CPAP compliance.ConclusionsThe presence of REM rebound, but not SWS rebound, on initial CPAP exposure is associated with early CPAP compliance. This increased compliance is not explained by severity of sleep apnea as measured by AHI.     

Predictors of symptoms of anxiety and depression in obstructive sleep apnea

BACKGROUND AND PURPOSE: To assess factors associated with anxiety and depression in patients with obstructive sleep apnea syndrome (OSAS). PATIENTS AND METHODS: The study was comprised of a postal survey with a hospital chart review. Questionnaires were mailed to 242 previously hospitalised patients with OSAS. We assessed anxiety and depression with the Hospital Anxiety and Depression scale (HAD). Scores on the two HAD scales (0-21 scale, higher scores represent poor health) were categorized as normal/borderline (< or =10), and corresponding to a clinical diagnosis of anxiety or depression (> or =11). In logistic regression analysis, we assessed the association with HAD scores > or =11, using variables from the chart review and self-reported data on demographics, disease history, smoking status, CPAP/BiPAP use, and daytime sleepiness as assessed with the Epworth Sleepiness Scale (ESS), as potential predictors. RESULTS: One hundred and seventy-eight patients (74%) with mean (SD) age 55 (11) years and body mass index (BMI) of 31 (5) kgm(-2) responded to the questionnaire. In multivariate logistic regression analysis, only low compliance with CPAP therapy (odds ratio (OR) 5.60, P=0.005) predicted high level of anxiety, and low compliance with CPAP therapy (OR 3.59, P=0.03) and daytime sleepiness (OR 1.14 per unit increase in ESS score, P=0.02) were the only predictors of high level of depression. CONCLUSIONS: High anxiety score was associated with non-compliance with CPAP therapy. High depression score was associated with daytime sleepiness and non-compliance with CPAP therapy.     

Improvement of EEG slowing in OSAS after CPAP treatment

ObjectivesThis study was done to investigate change of electroencephalography (EEG) slowing and its relationship to daytime sleepiness and cognitive functions by continuous positive airway pressure (CPAP) in patients with obstructive sleep apnea syndrome (OSAS).MethodsWe enrolled thirteen male subjects with severe OSAS, and all the subjects were treated with CPAP for 3 months. Quantitative EEG (QEEG) and neuropsychological tests were performed before and after CPAP treatment.ResultsAfter CPAP treatment, delta absolute power decreased in the frontal, central, parietal and temporal regions and the slowing ratio was reduced in the frontal region. The Epworth Sleepiness Scale (ESS) score was reduced after CPAP treatment. Reduction in the ESS score was correlated with a decrease in delta absolute power in the frontal region (r = 0.559) and a decrease in slowing ratio in frontal, central, parietal, and temporal regions (frontal, r = 0.650; other regions, r = 0.603). Results of neuropsychological tests assessing memory and attention were improved after CPAP treatment.ConclusionsEEG slowing was decreased across all cerebral regions in patients with severe OSAS after CPAP treatment accompanied by improvement of cognitive functions involving several brain areas. These findings suggest that CPAP can induce improvement of cerebral function in OSAS without regional specificity.     

A preliminary investigation of the effectiveness of a sleep apnea education program

OBJECTIVES: This study aimed to evaluate a standardised sleep apnea patient education program and develop a study design that may be used to evaluate other such education programs. METHOD: Thirty-four adults diagnosed with obstructive sleep apnea hypopnea syndrome (OSAHS) underwent a standard sleep apnea education program and completed measures of knowledge of and beliefs about sleep apnea before, after, and 3 months following education. Two outcome measures were used: the Apnea Knowledge Test (AKT) and the Apnea Beliefs Scale (ABS). RESULTS: AKT results showed significant knowledge gains posteducation, which were maintained at follow-up. Patients also reported more positive beliefs about their ability to change their behaviour and comply with continuous positive airway pressure (CPAP) treatment recommendations after education. DISCUSSION: Findings from this preliminary investigation suggest that the education program used in this study may improve patients' knowledge of CPAP and promote functional beliefs about OSAHS treatment. This program clearly warrants further research, and ultimately such programs may prove important in improving CPAP compliance.     

The Optiflow™ interface for chronic CPAP use in children

Continuous positive airway pressure (CPAP) is being increasingly used in children of all age ranges. The limited number of commercially available masks especially in infants and young children may complicate its use and compliance. In this report, we describe our experience with the use of the Optiflow™ (Fisher and Paykel Healthcare) Nasal Cannula attached to a regular CPAP device in the setting of chronic CPAP use. This interface consists of a nasal cannula and was originally designed for the delivery of high-flow oxygen therapy. We could show an objective improvement in breathing parameters in several children selected for CPAP mainly because of obstructive sleep apnea syndrome (OSAS). However, this interface cannot be used for bilevel non-invasive ventilation due to insufficient triggering.