Vol.95 No.12 contentsPRACTICA OTO-RHINO-LARYNGOLOGICA
Vol. 95 No. 12 December 2002
Nasal CPAP Treatment for OSAS in Otolaryngology
Tadao Nishimura and Chikaya Hattori
(Fujita Health University)
In 1998, nasal continuous positive airway pressure (nasal CPAP) was added to the list of Japanese health insurance-approved methods for treating obstructive sleep apnea syndrome (OSAS). Since then, nasal CPAP has been increasingly applied to patients with OSAS in Japan. This highlights the need for standardized ideas on non-surgical nasal CPAP if Japanese otorhinolaryngologists are to treat OSAS most effectively.
According to the terms and conditions of Japanese health insurance, nasal CPAP is covered by insurance for cases either over 40 in apnea hypopnea index (AHI) or over 20 in AHI with improvements in symptoms and PSG brain waves by the use of nasal CPAP.
The application of nasal CPAP requires titration. Some institutions in Japan employ the function of APAP, and a 90th centile pressure is often used.
OSAS is caused by obstruction of the upper respiratory tract, mainly around the pharynges. Therefore, specialists in this region should take progressive approaches to OSAS. Nasal CPAP is not applicable to patients with either severely- or completely-congested nose. In such a case, nasal surgery in combination with drug therapy are appropriate.
Generally speaking, patients introduced by internists and psychiatrists are often 5 to 20 in AHI, so nasal CPAP is not applicable in terms of Japanese health insurance. However, this does not necessarily mean that surgery is effective for them. The application of surgery depends on previous surgical data and types of OSAS.
Key words : OSAS, nasal CPAP, surgery