Many OSA patients repeatedly fail attempts at weaning from CPAP and face a substantial risk of becoming chronic CPAP-dependent patients who cannot sustain spontaneous breathing for longer than a few hours. They end up hooked on the CPAP rest of their life.
Chronic CPAP dependence is not only a major medical problem but it is also an extremely uncomfortable state for a patient, carrying important social implications. This is more important in young patients who suffer from OSA and not aware of the alternate surgical treatment.
Yet few investigators have attempted to determine the pathophysiologic mechanisms underlying weaning failure in long-term CPAP-dependent patients.
Causes- Brainstem activity for respiratory drive is taken over by CPAP leading to no spontaneous neuromuscular drive. As a result, these patients cannot breathe spontaneously.
Treatment- Aggressive surgical correction of obstructive pathology in the upper airway may be pursued. Treatment of obstructive sleep apnea is remove the obstruction, nothing else and it is logic.
Since I started surgical treatment for OSA and Snoring, I have dealt with many CPAP dependant patients and got rid of their CPAP. These patients need careful monitoring in the recovery stage after anesthesia (GA).
