[Treatment of primary and secondary therapy failure in patients with sleep apnea treated with nasal CPAP]

Two forms of treatment failure of nCPAP therapy should be distinguished: 1. Primary treatment failure: the reversal of apnoeas and hypopnoeas cannot be achieved due to central SA or a combination of MSA and central hypoventilation. In 10 patients who did not respond to nCPAP (7 patients with purely central SA and 3 patients with MSA who still demonstrated long phases of central hypoventilation during nCPAP) we performed a nasal intermittent positive pressure ventilation (nIPPV) during at least 3 treatment nights. In all patients a reversal of apnoeas and hypopnoeas could be achieved, despite a few phases of mask leakage. Due to possibly life threatening side effects continuous monitoring is required during the initial treatment phase. 8 patients who reported a reduction of symptoms have been successfully using the treatment at home for up to 22 months. 2. Secondary treatment failure: nCPAP leads to a normalisation of breathing pattern but patients refuse nCPAP or discontinue treatment. Besides patients who are poorly motivated there are four major side effects of nCPAP as a reason for non-compliance: a) drying out of the nasopharyngeal mucosa or rhinitis; b) pressure marks caused by the nose mask; c) intolerance to the high expiratory pressure; d) noise. Drying out of the mucosa and rhinitis are the most important side effects. If an increase of room temperature and humidity, nasal cream and small amounts of mint-oil as well as a heat-moisture exchanger (HME) prove inadequate, we use a heated humidifier (Dräger, Aquapor).(ABSTRACT TRUNCATED AT 250 WORDS)