ABSTRACT

CPAP (Continuous Positive Airway Pressure) is the treatment of choice for all patients with moderate and severe obstructive sleep apnea syndrome (OSAS). It is also the first step before any surgical procedure and can be used to predict mandibular advancement devices usefulness. CPAP usage has been shown to correct hypersomnia, improve quality of life, depression, cardiac function, to lower blood pressure levels, correct levels of inflammatory markers and ventilatory instability, to improve insulin sensitivity and to reduce the risk of traffic accidents in patients with OSAS. As it happens with other long term treatments, CPAP compliance is not always ideal. The present article will describe new options to achieve better compliance with the subsequent benefits for the patients.

KEYWORDS

CPAP, OSAS treatment, OSAS.

REFERENCES

1. Sullivan CE, Issa FG, Berthon-Jones M, Eves L. Reversal of obstructive sleep apnoea by continuous positive airway pressure applied through the nares. Lancet 1981;862-865.

2. Guilleminault C, Eldridge FL, Simmons FB, Dement WC. Sleep apnea in eight children. Pediatrics 1976;58:23-30.

3. Guilleminault C, Simmons FB, Motta J, et ál. Obstructive sleep apnea syndrome and tracheostomy. Long-term follow-up experience. Arch Intern Med 1981;141:985-988.

4. Wagner DR, Pollak CP, Weitzman ED. Nocturnal nasal-airway pressure for sleep apnea. N Engl J Med 1983;308:461-462.

5. Krieger J, Weitzenblum E, Monassier JP, Stoeckel C, Kurtz D. Dangerous hypoxaemia during continuous positive airway pressure treatment of obstructive sleep apnoea. Lancet 1983;2:1429-1430.

6. Jenkinson C, Davies RJ, Mullins R, Stradling JR. Comparison of therapeutic and subtherapeutic nasal continuous positive airway pressure for obstructive sleep apnoea: a randomized prospective parallel trial. Lancet 1999;353:2100-2105.

7. Giles TL, Lasserson TJ, Smith BJ, White J, Wright J, Cates CJ. Continuous positive airways pressure for obstructive sleep apnoea in adults. The Cochrane Database Syst Rev 2006;3:CD001106.

8. Epstein LJ, Kristo D, Strollo PJ Jr, et ál. Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med 2009;5:263-276.

9. Lloberes P, Durán-Cantolla J, Martínez-García MÁ, et ál. Diagnóstico y tratamiento de apneas-hipopneas durante el síndrome. Sociedad Española de Neumología y Cirugía Torácica. Arch Bronconeumol 2011;47:143-156.

10. Aurora RN, Casey KR, Kristo D, et ál. Practice parameters for the surgical modifications of the upper airway for obstructive sleep apnea in adults. Sleep 2010;33:1408-1413.

11. Tsuiki S, Kobayashi M, Namba K, et ál. Optimal positive airway pressure predicts oral appliance response to sleep apnoea. Eur Respir J 2010;35:1098-1105.

12. Bouscoulet LT, Vázquez-García JC, Muiño A, et ál. Prevalence of sleep related symptoms in four Latin American cities. J Clin Sleep Med 2008;4:579-585.

13. Peppard PE, Young T, Palta M, Dempsey J, Skatrud J. Longitudinal study of moderate weight change and sleep-disordered breathing. JAMA 2000;284:3015-3021.

14. Young T, Evans L, Finn L, Palta M. Estimation of the clinically diagnosed proportion of sleep apnea syndrome in middle-aged men and women. Sleep 1997;20:705-706.

15. Jurado-Gamez B, Martín-Malo A, Alvarez-Lara MA, Muñoz L, Cosano A, Aljama P. Sleep disorders are underdiagnosed in patients on maintenance hemodialysis. Nephron Clin Pract 2007;105:35-42.

16. Jahaveri S, Caref EB, Chen E, Tong KB, Abraham WT. Sleep apnea testing and outcomes in a large cohort of Medicare beneficiaries with newly diagnosed heart failure. Am J Respir Crit Care Med 2011;183:539-456.

17. Marshall NS, Wong KK, Liu PY, Cullen SR, Knuiman MW, Grunstein RR. Sleep apnea as an independent risk factor for all-cause mortality: the Busselton Health Study. Sleep 2008;31:1079-1085.

18. Young T, Finn L, Peppard PE, et ál. Sleep disordered breathing and mortality: eighteen-year follow-up of the Wisconsin sleep cohort. Sleep 2008;31:1071-1078.

19. Punjabi NM, Caffo BS, Goodwin JL, et ál. Sleep-disordered breathing and mortality: a prospective cohort study. PLos Med 2009;6:e1000132.

20. Lavie P, Lavie L, Herer P. All-cause mortality in males with sleep apnoea syndrome: declining mortality rates with age. Eur Respir J 2005;25:514-520.

21. Young T, Shahar E, Nieto FJ, et ál. Predictors of sleep-disordered breathing in community-dwelling adults: the Sleep Heart Health Study. Arch Intern Med 2002;162:893-900.

22. Quan SF, Budhiraja R, Parthasarathy S. Is there a bidirectional relationship between obesity and sleep-disordered breathing? J Clin Sleep Med 2008;4:210-211.

23. Pillar G, Shehadeh N. Abdominal fat and sleep apnea: The chicken or the egg? Diabetes Care 2008;31(Suppl 2):303-309.

24. Mehra R, Redline S. Sleep apnea: a proinflammatory disorder that coaggregates with obesity. J Allergy Clin Immunol 2008;121:1096-1102.

25. Shamsuzzaman AS, Gersh BJ, Somers VK. Obstructive sleep apnea: implications for cardiac and vascular disease. JAMA 2003;290:1906-1914.

26. Marín JM, Carrizo SJ, Vicente E, Agusti AG. Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study. Lancet 2005;365:1046-53.

27. Kohler M, Pepperell JC, Casadei B, et ál. CPAP and measures of cardiovascular risk in males with OSAS. Eur Respir J 2008;32:1488-1496.

28. Stevenson IH, Teichtahl H, Cunnington D, Ciavarella S, Gordon I, Kalman JM. Prevalence of sleep disordered breathing in paroxysmal and persistent atrial fibrillation patients with normal left ventricular function. Eur Heart J 2008;29:1662-1669.

29. Kasai T, Bradley TD. Obstructive sleep apnea and heart failure: pathophysiologic and therapeutic implications. J Am Coll Cardiol 2011;57:119-127.

30. Saruhara H, Takata Y, Usui Y, et ál. Obstructive sleep apnea as a potential risk factor for aortic disease. Heart Vessels 2011 Mar 26.

31. Baguet JP, Nadra M, Barone-Rochette G, Ormezzano O, Pierre H, Pépin JL. Early cardiovascular abnormalities in newly diagnosed obstructive sleep apnea. Vasc Health Risk Manag 2009;5:1063-1073.

32. Villa MP, Ianniello F, Tocci G, et ál. Early cardiac abnormalities and increased C-reactive protein levels in a cohort of children with sleep disordered breathing. Sleep Breath 2011 Jan 6.

33. Kim J, Bhattacharjee R, Kheirandish-Gozal L, Spruyt K, Gozal D. Circulating microparticles in children with sleep disordered breathing. Chest 2011;140:408-417.

34. Choi JB, Nelesen R, Loredo JS, et ál. Sleepiness in obstructive sleep apnea: a harbinger of impaired cardiac function? Sleep 2006;29:1531-1536.

35. Alonso-Fernández A, García-Río F, Arias MA, et ál. Obstructive sleep apnoea-hypoapnoea syndrome reversibly depresses cardiac response to exercise. Eur Heart J 2006;27:207-215.

36. Chobanian AV, Bakris GL, Black HR, et ál. Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension 2003;42:1206-1252.

37. Gonçalves SC, Martinez D, Gus M, et ál. Obstructive sleep apnea and resistant hypertension: a case-control study. Chest 2007;132:1858-1862.

38. Quercioli A, Mach F, Montecucco F. Inflammation accelerates atherosclerotic processes in obstructive sleep apnea syndrome (OSAS). Sleep Breath 2010;14:261-269.

39. Lefebvre B, Pépin JL, Baguet JP, et ál. Leukotriene B4: early mediator of atheroesclerosis in obstructive sleep apnoea? Eur Respir J 2008;32:113-120.

40. Peker Y, Carlson J, Hedner J. Increased incidence of coronary artery disease in sleep apnoea: a long-term follow-up. Eur Respir J 2006;28:596-602.

41. Sorajja D, Gami AS, Somers VK, Behrenbeck TR, García-Touchard A, López-Jiménez F. Independent association between obstructive sleep apnea and subclinical coronary artery disease. Chest 2008;133:927-933.

42. Dyken ME, Im KB. Obstructive sleep apnea and stroke. Chest 2009;136:1668-1677.

43. Redline S, Yenokyan G, Gottlieb DJ, et ál. Obstructive sleep apnea-hypopnea and incident stroke: the sleep heart health study. Am J Respir Crit Care Med 2010;182:269-277.

44. Gami AS, Hodge DO, Herges RM, et ál. Obstructive sleep apnea, obesity, and the risk of incident atrial fibrillation. J Am Coll Cardiol 2007;49:565-571.

45. Garrigue S, Pépin JL, Defaye P, et ál. High prevalence of sleep apnea syndrome in patients with long-term pacing: the European Multicenter Polysomnographic Study. Circulation 2007;115:1703-1709.

46. Mason RH, Ruegg G, Perkins J, et ál. Obstructive sleep apnea in patients with abdominal aortic aneurysms: highly prevalent and associated with aneurysm expansion. Am J Respir Crit Care Med 2011;183:668-674.

47. Ip MS, Lam B, Ng MM, Tsang KW, Lam KS. Obstructive sleep apnea is independently associated with insulin resistance. Am J Respir Crit Care Med 2002;165:670-670.

48. Punjabi NM, Sorkin JD, Katzel LI, Goldberg AP, Schwartz AR, Smith PL. Sleep-disordered breathing and insulin resistance in middle-age and overweight men. Am J Respir Crit Care Med 2002;165:677-682.

49. Meslier N, Gagnadoux F, Giraud P, et ál. Impaired glucose-insulin metabolism in males with obstructive sleep apnoea syndrome. Eur Respir J 2003;22:156-160.

50. Punjabi NM, Shahar E, Redline S, et ál. Sleep-disordered breathing, glucose intolerance, and insulin resistance: the Sleep Heart Health Study. Am J Epidemiol 2004;160:521-530.

51. Barceló A, Barbe F, de la Peña M, et ál. Insulin resistance and daytime sleepiness in patients with sleep apnoea. Thorax 2008;63:946-950.

52. Punjabi NM, Beamer BA. Alterations in glucose disposal in sleep-disorder breathing. Am J Respir Crit Care Med 2009;179:235-240.

53. Papanas N, Steiropoulos P, Nena E, et ál. HbA1c is associated with severity of obstructive sleep apnea hypopnea syndrome in nondiabetic men. Vasc Health Risk Manag 2009;5:751-756.

54. Kelly A, Dougherty S, Cucchiara A, Marcus CL, Brooks LJ. Catecholamines, adiponectin, and insulin resistance as measured by HOMA in children with obstructive sleep apnea. Sleep 2010;33:1185-1191.

55. Tamura A, Kawano Y, Watanabe T, Kadota J. Relationship between the severity of obstructive sleep apnea and impaired glucose metabolism in patients with obstructive sleep apnea. Respir Med 2008;102:1412-1416.

56. Norman D, Bardwell WA, Arosemena F, et ál. Serum aminotransferase levels are associated with markers of hypoxia in patients with obstructive sleep apnea. Sleep 2008;31:121-126.

57. Polotsky VY, Patil SP, Savransky V, et ál. Obstructive sleep apnea, insulin resistance, and steatohepatitis in severe obesity. Am J Respir Crit Care Med 2009;179:228-234.

58. Verhulst SL, Jacobs S, Aerts L, et ál. Sleep-disordered breathing: a new risk factor of suspected fatty liver disease in overweight children and adolescents? Sleep Breath 2009;13:207-210.

59. Robinson GV, Pepperell JC, Segal HC, Davies RJ, Stradling JR. Circulating cardiovascular risk factors in obstructive sleep apnoea: data from randomized controlled trials. Thorax 2004;59:777-782.

60. Gozal D, Capdevila OS, Kheirandish-Gozal L. Metabolic alterations and systemic inflammation in obstructive sleep apnea among nonobese and obese prepubertal children. Am J Respir Crit Care Med 2008;177:1142-1149.

61. Marshall NS, Wong KK, Phillips CL, Liu PY, Knuiman MW, Grunstein RR. Is sleep apnea an independent risk factor for prevalent and incident diabetes in the Busselton Health Study? J Clin Sleep Med 2009;5:15-20.

62. Botros N, Concato J, Mohsenin V, Selim B, Doctor K, Yaggi HK. Obstructive sleep apnea as a risk factor for type 2 diabetes. Am J Med 2009;122:1122-1127.

63. Ronksley PE, Hemmelgarn BR, Heitman SJ, et ál. Obstructive sleep apnoea is associated with diabetes in sleepy subjects. Thorax 2009;64:834-839.

64. Celen YT, Hedner J, Carlson J, Peker Y. Impact of gender on incident diabetes mellitus in obstructive sleep apnea: a 16-year follow-up. J Clin Sleep Med 2010;6:244-250.

65. Muraki I, Tanigawa T, Yamagishi K, et ál. Nocturnal intermittent hypoxia and the development of type 2 diabetes: the Circulatory Risk in Communities Study (CIRCS). Diabetologia 2010;53:481-488.

66. Alva P JL. Consecuencias metabólicas y cardiovasculares del síndrome de apnea obstructiva del sueño. Med Int Mex 2009;25:116-128.

67. Arnardottir ES, Mackiewicz M, Gislason T, Teff KL, Pack AI. Molecular signatures of obstructive sleep apnea in adults: a review and perspective. Sleep 2009;32:447-470.

68. Kotani K, Kimura S, Komada I, Sakane N, Gugliucci A. Continuous positive air pressure treatment reduces serum advanced glycation end products in patients with obstructive sleep apnoea syndrome: a pilot study. Prim Care Respir J 2011;20:336-337.

69. Tamisier R, Pépin JL, Rémy J, et ál. 14 nights of intermittent hypoxia elevate daytime blood pressure and sympathetic activity in healthy humans. Eur Respir J 2011;37:119-128.

70. Kohler M, Craig S, Nicoll D, Leeson P, Davies RJ, Stradling JR. Endothelial function and arterial stiffness in minimally symptomatic obstructive sleep apnea. Am J Respir Crit Care Med 2008;178:984-988.

71. Ayers L, Ferry B, Craig S, Nicoll D, Stradling JR, Kohler M. Circulating cell-derived microparticles in patients with minimally symptomatic obstructive sleep apnoea. Eur Respir J 2009;33:574-580.

72. AlGhanim N, Comondore VR, Fleetham J, Marra CA, Ayas NT. The economic impact of obstructive sleep apnea. Lung 2008;186:7-12.

73. Banno K, Ramsey C, Walld R, Kryger MH. Expenditure on health care in obese women with and without sleep apnea. Sleep 2009;32;247-252.

74. Jennum P, Kjellberg J. Health social and economical consequences of sleep-disordered breathing: a controlled national study. Thorax 2011;66:560-566.

75. Nena E, Steiropoulos P, Constantinidis TC, Perantoni E, Tsara V. Work productivity in obstructive sleep apnea patients. J Occup Environ Med 2010;52:622-625.

76. Tregear S, Reston J, Schoelles K, Phillips B. Obstructive sleep apnea and risk of motor vehicle crash: systematic review and meta-analysis. J Clin Sleep Med 2009;5:573-581.

77. Krieger J, McNicholas WT, Levy P, et ál. Public health and medicolegal implications of sleep apnoea. Eur Respir J 2002;20:1594-1609.

78. Gregory GA, Kitterman JA, Phibbs RH, Tooley WH, Hamilton WK. Treatment of the idiopathic respiratory-distress syndrome with continuous positive airway pressure. N Engl J Med 1971;284:1333-1340.

79. Greenbaum DM, Millen JE, Eross B, Snyder JV, Grenvik A, Safar P. Continuous positive airway pressure without tracheal intubation in spontaneously breathing patients. Chest 1976;69:615-620.

80. Remmers JE, deGroot WJ, Sauerland EK, Anch AM. Pathogenesis of upper airway occlusion during sleep. J Appl Physiol 1978;44:931-938.

81. Schwab RJ, Pack AI, Gupta KB, et ál. Upper airway and soft tissue structural changes induced by CPAP in normal subjects. Am J Respir Crit Care Med 1996;154:1106-1116.

82. Corda L, Redolfi S, Montemurro LT, La Piana GE, Bertella E, Tantucci C. Short-and long-term effects of CPAP on upper airway anatomy and collapsibility in OSAH. Sleep Breath 2009;13:187-193.

83. Salloum A, Rowley JA, Mateika JH, Chowdhuri S, Omran Q, Badr MS. Increased propensity for central apnea in patients with obstructive sleep apnea: effect of nasal continuous positive airway pressure. Am J Respir Crit Care Med 2010;181:189-193.

84. Morisson F, Décary A, Petit D, Lavigne G, Malo J, Montplaisir J. Daytime sleepiness and EEG spectral analysis in apneic patients before and after treatment with continuous positive airway pressure. Chest 2001;119:45-52.

85. Patel SR, White DP, Malhotra A, Stanchina ML, Ayas NT. Continuous positive airway pressure therapy for treating sleepiness in a diverse population with obstructive sleep apnea: results of a meta-analysis. Arch Intern Med 2003;163:565-571.

86. Siccoli NM, Pepperell JC, Kohler M, Craig SE, Davies RJ, Stradling JR. Effects of continuous positive airway pressure on quality of life in patients with moderate to severe obstructive sleep apnea: data from a randomized controlled trial. Sleep 2008;31:1551-1558.

87. Antic NA, Catcheside P, Buchan C, et ál. The effect of CPAP in normalizing daytime sleepiness, quality of life, and neurocognitive function in patients with moderate to severe OSA. Sleep 2011;34:111-119.

88. Tomfohr LM, Ancoli-Israel S, Loredo JS, Dimsdale JE. Effects of continuous positive airway pressure on fatigue and sleepiness in patients with obstructive sleep apnea: data from a randomized controlled trial. Sleep 2011;34:121-126.

89. Zhao Q, Liu ZH, Luo Q, Zhao ZH, Zhang HL, Wang Y. Effects of continuous positive airway pressure on blood pressure and daytime sleepiness in obstructive sleep apnea patients with coronary heart diseases under optimal medications. Sleep Breath 2011.

90. Engleman HM, Martin SE, Deary IJ, Douglas NJ. Effect of CPAP therapy on daytime function in patients with mild sleep apnoea/hypopnoea syndrome. Thorax 1997;52:114-119.

91. Engleman HM, Kingshott RN, Wraith PK, Mackay TW, Deary IJ, Douglas NJ. Randomized placebo-controlled crossover trial of continuous positive airway pressure for mild sleep Apnea/Hypopnea syndrome. Am J Respir Crit Care Med 1999;159:461-467.

92. Canessa N, Castronovo V, Cappa SF, et ál. Obstructive sleep apnea: brain structural changes and neurocognitive function before and after treatment. Am J Respir Crit Care Med 2011;183:1419-1426.

93. Gozal D, Kheirandish-Gozal L, Bhattacharjee R, Spruyt K. Neurocognitive and endothelial dysfunction in children with obstructive sleep apnea. Pediatrics 2010;126:1161-1167.

94. Brockmann PE, Urschitz MS, Schland M, Poets CF. Primary snoring in school children: prevalence and neurocognitive impairments. Sleep Breath 2011 Jan 16.

95. Quan SF, Chan CS, Dement WC, et ál. The association between obstructive sleep apnea and neurocognitive performance-the Apnea Positive Pressure Long-term Efficacy Study (APPLES). Sleep 2011;34:303-314B.

96. Joo EY, Tae WS, Lee MJ, et ál. Reduced brain gray matter concentration in patients with obstructive sleep apnea syndrome. Sleep 2010;33:235-241.

97. Bazzano LA, Khan Z, Reynolds K, He J. Effect of nocturnal nasal continuous positive airway pressure on blood pressure in obstructive sleep apnea. Hypertension 2007;50:417-423.

98. Martínez-García MA, Gómez-Aldaraví R, Soler-Cataluña JJ, Martínez TG, Bernácer-Alpera B, Román-Sánchez P. Positive effect of CPAP treatment on the control of difficult-to-treat hypertension. Eur Respir J 2007;29:951-957.

99. Robinson GV, Langford BA, Smith DM, Stradling JR. Predictors of blood pressure fall with continuous positive airway pressure (CPAP) treatment of obstructive sleep apnoea (OSA). Thorax 2008;63:855-859.

100. Hui DS, To KW, Ko FW, et ál. Nasal CPAP reduces systemic blood pressure in patients with obstructive sleep apnoea and mild sleepiness. Thorax 2006;61:1083-1090.

101. Barbé F, Durán-Cantolla J, Capote F, et ál. Long term effect of continuous positive airway pressure in hypertensive patients with sleep apnea. Am J Respir Crit Care Med 2010;181:718-726.

102. Drager LF, Pedrosa RP, Diniz PM, et ál. The effects of continuous positive airway pressure on prehypertension and masked hypertension in men with severe obstructive sleep apnea. Hypertension 2011;57:549-555.

103. Pépin JL, Tamisier R, Barone-Rochette G, Launois SH, Lévy P, Baguet JP. Comparison of continuous positive airway pressure and valsartan in hypertensive patients with sleep apnea. Am J Respir Crit Care Med 2010;182:954-960.

104. Shiina K, Tomiyama H, Takata Y, et ál. Effects of CPAP therapy on the sympathovagal balance and arterial stiffness in obstructive sleep apnea. Respir Med 2010;104:911-916.

105. Eryilmaz S, Aydinlar A, Senturk T, Ursavas A, Aydin Kaderli A, Ozdemir B. Continuous positive airway pressure therapy improves arterial elasticity in patients with obstructive sleep apnea. Respir Med 2010;104:1571-1576.

106. Navarro-Antolín J, Carmona-Bernal C, Rivero-Valdenebro V, Villar J, Capote F, López-Barneo J. Maxi-K+ channel beta1 expression in sleep apnea patients and its modulation by CPAP treatment. Am J Hypertens 2009;22:197-202.

107. Bayram NA, Ciftci B, Keles T, et ál. Endothelial function in normotensive men with obstructive sleep apnea before and 6 months after CPAP treatment. Sleep 2009;32:1257-1263.

108. Somers VK, White DP, Amin R, et ál. Sleep apnea and cardiovascular disease: an American Heart Association/American College of Cardiology Foundation Scientific Statement from the American Heart Association Council for High Blood Pressure Research Professional Education Committee, Council on Clinical Cardiology, Stroke Council, and Council on Cardiovascular Nursing Council. Circulation 2008;118:1080-1111.

109. von Känel R, Loredo JS, Ancoli-Israel S, Dimsdale JE. Association between sleep apnea severity and blood coagulability: Treatment effects of nasal continuous positive airway pressure. Sleep Breath 2006;10:139-146.

110. Mehra R, Xu F, Babineau DC, et ál. Sleep-disordered breathing and pro-thrombotic biomarkers: cross-sectional results of the Cleveland Family Study. Am J Respir Crit Care Med 2010;182:826-833.

111. El Solh AA, Akinnusi ME, Berim IG, Peter AM, Pasch LL, Szarpa KR. Hemostatic implications of endothelial cell apoptosis in obstructive sleep apnea. Sleep Breath 2008;12:331-337.

112. Arias MA, García-Río F, Alonso-Fernández A, et ál. CPAP decreases plasma levels of soluble tumour necrosis factor-alpha receptor 1 in obstructive sleep apnoea. Eur Respir J 2008;32:1009-1015.

113. Kohler M, Pepperell JC, Casadei B, et ál. CPAP and measures of cardiovascular risk in males with OSAS. Eur Respir J 2008;32:1488-1496.

114. Steiropoulos P, Kotsianidis I, Nena E, et ál. Long-Term effect of continuous positive airway pressure therapy on inflammation markers of patients with obstructive sleep apnea syndrome. Sleep 2009;32:537-543.

115. Wu KM, Lin CC, Chiu CH, Liaw SF. Effect of treatment by nasal continuous positive airway pressure on serum high mobility group box-1 protein in obstructive sleep apnea. Chest 2010;137:303-309.

116. Celec P, Hodosy J, Behuliak M, et ál. Oxidative and carbonyl stress in patients with obstructive sleep apnea treated with continuous positive airway pressure. Sleep Breath 2011 Mar 26.

117. Hegglin A, Schoch OD, Korte W, Hahn K, Hürny C, Münzer T. Eight months of continuous positive airway pressure (CPAP) decrease tumor necrosis factor alpha (TNFA) in men with obstructive sleep apnea syndrome. Sleep Breath 2011.

118. Christou K, Kostikas K, Pastaka C, Tanou K, Antoniadou I, Gourgoulianis KI. Nasal continuous positive airway pressure treatment reduces systemic oxidative stress in patients with severe obstructive sleep apnea syndrome. Sleep Med 2009;10:87-94.

119. Alonso-Fernández A, García-Río F, Arias MA, et ál. Effects of CPAP on oxidative stress and nitrate efficiency in sleep apnoea: a randomized trial. Thorax 2009;64:581-586.

120. Jurado-Gámez B, Fernández-Marín MC, Gómez-Chaparro JL, et ál. Relationship of oxidative stress and endothelial dysfunction in sleep apnoea. Eur Respir J 2011;37:873-879.

121. Kotani K, Kimura S, Komada I, Sakane N, Gucliucci A. Continuous positive air pressure treatment reduces serum advanced glycation end products in patients with obstructive sleep apnoea syndrome: a pilot study. Prim Care Respir J 2011;20:336-337.

122. Büchner N, Quack I, Woznowski M, Stähle C, Wenzel U, Rump L. Microvascular endothelial dysfunction in obstructive sleep apnea is caused by oxidative stress and improved by continuous positive airway pressure therapy. Respiration 2011;82:409-417.

123. Börgel J, Sanner BM, Bittlinsky A, et ál. Obstructive sleep apnoea and its therapy influence high-density lipoprotein cholesterol serum levels. Eur Respir J 2006;27:121-127.

124. Cuhadaroğlu C, Utkusavaş A, Oztürk L, Salman S, Ece E. Effects of nasal CPAP treatment on insulin resistance, lipid profile, and plasma leptin in sleep apnea. Lung 2009;187:75-81.

125. Abe H, Takahashi M, Yaegashi H, et ál. Efficacy of continuous positive airway pressure on arrhythmias in obstructive sleep apnea patients. Heart Vessels 2010;25:63-69.

126. Oliveira W, Campos O, Cintra F, et ál. Impact of continuous positive airway pressure treatment on left atrial volume and function in patients with obstructive sleep apnoea assessed by real time three-dimensional echocardiography. Heart 2009;95:1872-1878.

127. Reichmuth KJ, Dopp JM, Barczi SR, et ál. Impaired vascular regulation in patients with obstructive sleep apnea: effects of continuous positive airway pressure treatment. Am J Respir Crit Care Med 2009;180:1143-1150.

128. Jelic S, Lederer DJ, Adams T, et ál. Endothelial repair capacity and apoptosis are inversely related in obstructive sleep apnea. Vasc Health Risk Manag 2009;5:909-920.

129. Maeder MT, Ammann P, Münzer T, et ál. Continuous positive airway pressure improves exercise capacity and heart rate recovery in obstructive sleep apnea. Int J Cardiol 2009;132:75-83.

130. Cordero-Guevara J, Terán-Santos J, Alonso-Álvarez ML, Castrodeza-Sanz J, Ordax-Carbajo E, Masa-Jiménez F. Effectiveness of nasal continuous positive airway pressure (CPAP) therapy on cardiovascular outcomes in Obstructive Sleep Apnea-Hypopnea Syndrome (OSAHS). Curr Respir Med Rev 2011;7:121-129.

131. Phillips B. Your tax dollars at work! or the APPLES trial bears fruit. J Clin Sleep Med 2008;4:419-420.

132. Lavie L, Lavie P. Ischemic preconditioning as a possible explanation for the age decline relative mortality in sleep apnea. Med Hypotheses 2006;66:1069-1073.

133. Steiner S, Scheuller PO, Schulze V, Strauer BE. Occurrence of coronary collateral vessels in patients with sleep apnea and total coronary occlusion. Chest 2010;137:516-520.

134. Redline S, Yenokyan G, Gottlieb DJ, et ál. Obstructive Sleep apnea-hypopnea and incident stroke: the sleep heart health study. Am J Respir Crit Care Med 2010;182:269-277.

135. Reichmuth KJ, Dopp JM, Barczi SR, et ál. Impaired vascular regulation in patients with obstructive sleep apnea: effects of continuous positive airway pressure treatment. Am J Respir Crit Care Med 2009;180:1143-1150.

136. Morgan BJ, Reichmuth KJ, Peppard PE, et ál. Effects of sleep-disordered breathing on cerebrovascular regulation: a population-based study. Am J Respir Crit Care Med 2010;182:1445-1452.

137. Minoguchi K, Yokoe T, Tazaki T, et ál. Silent brain infarction and platelet activation in obstructive sleep apnea. Am J Respir Crit Care Med 2007;175:612-617.

138. Martínez-García MA, Soler-Cataluña JJ, Ejarque-Martínez L, et ál. Continuous positive airway pressure treatment reduces mortality in patients with ischemic stroke and obstructive sleep apnea: a 5-year follow-up study. Am J Respir Crit Care Med 2009;180:36-41.

139. Dziewas R, Schilling M, Engel P, et ál. Treatment for obstructive sleep apnea: effect on peripheral nerve function. J Neurol Neurosurg Psychiatry 2007;78:295-297.

140. Schwartz DJ, Karatinos G. For individuals with obstructive sleep apnea, institution of CPAP therapy is associated with an amelioration of symptoms of depression which is sustained long term. J Clin Sleep Med 2007;3:631-635.

141. Tregear S, Reston J, Schoelles K, Phillips B. Continuous positive airway pressure reduces risk of motor vehicle crash among drivers with obstructive sleep apnea: systematic review and meta-analysis. Sleep 2010;33:1373-1380.

142. Dorkova Z, Petrasova D, Molcanyiova A, Popovnakova M, Tkacova R. Effects of continuous positive airway pressure on cardiovascular risk profile in patients with severe obstructive sleep apnea and metabolic syndrome. Chest 2008;134:686-692.

143. Punjabi NM, Beamer BA. Alterations in glucose disposal in sleep-disordered breathing. Am J Respir Crit Care Med 2009;179:235-240.

144. Tasali E, Chapotot F, Leproult R, Whitmore H, Ehrmann DA. Treatment of obstructive sleep apnea improves cardiometabolic function in young obese women with polycystic ovary syndrome. J Clin Endocrinol Metab 2011;96: 365-374.

145. Lam JC, Lam B, Yao TJ, et ál. A randomized controlled trial of nasal continuous positive airway pressure on insulin sensitivity in obstructive sleep apnoea. Eur Respir J 2010;35:138-145.

146. Pamidi S, Aronsohn RS, Tasali E. Obstructive sleep apnea: role in the risk and severity of diabetes. Best Pract Res Clin Endocrinol Metab 2010;24:703-715.

147. Clarenbach CF, West SD, Kohler M. Is obstructive sleep apnea a risk factor for diabetes? Discov Med 2011;12:17-24.

148. Shaw JE, Punjabi NM, Wilding JP, Alberti KG, Zimmet PZ. Sleep-disordered breathing and type 2 diabetes: a report from the International Diabetes Federation Taskforce on Epidemiology and Prevention. Diabetes Res Clin Pract 2008;81:2-12.

149. Handelsman Y, Mechanick JI, Blonde L, et ál. American Association of Clinical Endocrinologists Medical Guidelines for Clinical Practice for developing a diabetes mellitus comprehensive care plan. Endocr Pract 2011;17(Suppl 2):1-53.

150. Nieminen MS, Böhm M, Cowie MR, et ál. Executive summary of the guidelines on the diagnosis and treatment of acute heart failure: the Task Force on Acute Heart Failure of the European Society of Cardiology. Eur Heart J 2005;26:384-416.

151. Zarbock A, Mueller E, Netzer S, Gabriel A, Feindt P, Kindgen-Milles D. Prophylactic nasal continuous positive airway pressure following cardiac surgery protects from postoperative pulmonary complications: a prospective, randomized, controlled trial in 500 patients. Chest 2009;135:1252-1259.

152. Santamaria J, Iranzo A, Ma Montserrat J, de Pablo J. Persistent sleepiness in CPAP treated obstructive sleep apnea patients: evaluation and treatment. Sleep Med Rev 2007;11:195-207.

153. Koutsourelakis, Perraki E, Economou NT, et ál. Predictors of residual sleepiness in adequately treated obstructive sleep apnoea patients. Eur Respir J 2009;34:687-693.

154. Pepin JL, Leger P, Veale D, Langevin B, Robert D, Lévy P. Side effects of nasal continuous positive airway pressure in sleep apnea syndrome. Study of 193 patients in two French sleep centers. Chest 1995;107:375-381.

155. Almendros I, Acerbi I, Villaseca I, Montserrat JM, Navajas D, Farré R. Continuous positive airway pressure (CPAP) induces early nasal inflammation. Sleep 2008;31:127-131.

156. Ruhle KH, Franke KJ, Domanski U, Nilius G. Quality of life, compliance, sleep and nasopharyngeal side effects during CPAP therapy with and without controlled heated humidification. Sleep Breath 2011;15:479-485.

157. Koutsourelakis I, Vagiakis E, Perraki E, et ál. Nasal inflammation in sleep apnoea patients using CPAP and effect of heated humidification. Eur Respir J 2011;37:587-594.

158. Korczynski P, Gorska K, Przybylowski T, Bielicki P, Zielinski J, Chazan R. Continuous positive airway pressure treatment increases bronchial reactivity in obstructive sleep apnea patients. Respiration 2009;78:404-410.

159. Lin CC, Lin CY. Obstructive sleep apnea syndrome and bronchial hyperreactivity. Lung 1995;173:117-126.

160. Lafond C, Sériès F, Lemière C. Impact of CPAP on asthmatic patients with obstructive sleep apnoea. Eur Respir J 2007;29:307-311.

161. Alharbi M, Almutairi A, Alotaibi D, Alotaibi A, Shaikh S, Bahammam AS. The prevalence of asthma in patients with obstructive sleep apnoea. Prim Care Respir J 2009;18:328-330.

162. Yigla M, Tov N, Solomonov A, Rubin AH, Harlev D. Difficult-to-control asthma and obstructive sleep apnea. J Asthma 2003;40:865-871.

163. Ciftci TU, Ciftci B, Guven SF, Kokturk O, Turktas H. Effect of nasal continuous positive airway pressure in uncontrolled nocturnal asthmatic patients with obstructive sleep apnea syndrome. Respir Med 2005;99:529-534.

164. Buchanan PR, Grunstein RR. Continuous positive airway pressure. In: Kushida CA, editor. Obstructive sleep apnea diagnosis and treatment. USA; 2007:101-124.

165. Collen J, Holley A, Lettieri C, Shah A, Roop S. The impact of split-night versus traditional sleep studies on CPAP compliance. Sleep Breath 2010;14:93-99.

166. Pépin JL, Muir JF, Gentina T, et ál. Pressure reduction during exhalation in sleep apnea patients treated by continuous positive airway pressure. Chest 2009;136;490-497.

167. Vennelle M, White S, Riha RL, et ál. Randomized controlled trial of variable-pressure versus fixed-pressure continuous positive airway pressure (CPAP) treatment for patients with obstructive sleep apnea/hypopnea syndrome (OSAHS). Sleep 2010;33:267-271.

168. Bakker J, Campbell A, Neill A. Randomized controlled trial comparing flexible and continuous positive airway pressure delivery: effects on compliance, objective and subjective sleepiness and vigilance. Sleep 2010;33:523-529.

169. Bakker JP, Marshall NS. Flexible pressure delivery modification of continuous positive airway pressure for obstructive sleep apnea does not improve compliance with therapy: systematic review and meta-analysis. Chest 2011;139:1322-1330.

170. Damjanovic D, Fluck A, Bremer H, Müller-Quernheim J, Idzko M, Sorichter S. Compliance in sleep apnoea therapy: influence of home care support and pressure mode. Eur Respir J 2009;33:804-811.

171. Torre-Bouscoulet L, López-Escárcega E, Castorena-Maldonado A, Vázquez-García JC, Meza-Vargas MS, Pérez-Padilla R. Uso de CPAP en adultos con síndrome de apneas obstructivas durante el sueño después de prescripción en un hospital público de referencia de la Ciudad de México. Arch Bronconeumol 2007;43:16-21.

172. Lettieri CJ, Collen JF, Eliasson AH, Quast TM. Sedative use during continuous positive airway pressure titration improves subsequent compliance a randomized, double-blind, placebo-controlled trial. Chest 2009;136:1263-1268.

173. Collen J, Lettieri C, Kelly W, Roop S. Clinical and polysomnographic predictors of short-term continuous positive airway pressure compliance. Chest 2009;135:704-709.

174. Lettieri CJ, Shah AA, Holley AB, et ál. Effects of a short course of eszopiclone on continuous positive airway pressure adherence a randomized trial. Ann Intern Med 2009;151:696-702.

175. Emilsson M, Berndtsson I, Lötvall J, et ál. The influence of personality traits and beliefs about medicines on adherence to asthma treatment. Prim Care Respir J 2011;20:141-147.

176. Platt AB , Kuna ST, Field SH, et ál. Adherence to sleep apnea therapy and use of lipid-lowering drugs a study of the healthy-user effect. Chest 2010;137:102-108.

177. Simon-Tuval T, Reuveni H, Greenberg-Dotan S, Oksenberg A, Tal A, Tarasiuk A. Low socioeconomic status is a risk factor for CPAP acceptance among adult OSAS patients requiring treatment. Sleep 2009;32:545-552.

178. Platt AB, Field SH, Asch DA, et ál. Neighborhood of residence is associated with daily adherence to CPAP therapy. Sleep 2009;32:799-806.

179. Davidsen JR, Søndergaard J, Hallas J, et ál. Impact of socioeconomic status on the use of inhaled corticosteroids in young adult asthmatics. Respir Med 2011;105:683-690.

180. Rosenfeld L, Rudd R, Emmons KM, Acevedo-García D, Martin L, Buka S. Beyond reading alone: the relationship between aural literacy and asthma management. Patient Educ Couns 2011;82:110-116.

181. Chen E, Strunk RC, Bacharier LB, Chan M, Miller GE. Socioeconomic status associated with exhaled nitric oxide responses to acute stress in children with asthma. Brain Behav Immun 2010;24:444-450.

182. Shapiro GK, Shapiro CM. Factors that influence CPAP adherence: an overview. Sleep Breath 2010;14:323-335.