Past, Present and Future of CPAP
Could we use it as a treatment? We decided to leave the patient on the pressure for the rest of the night. We watched as he continued to sleep for around 7 hours, without any apnea, and with the most extraordinarily intense sleep patterns. The patient’s response the next day was equally exciting. He was awake and alert for the first time in years.
There have been many pivotal moments since, but this was the start of the nasal CPAP era. Over the next several years we did many experiments in which we used the method to demonstrate and dissect the many adverse outcomes that sleep apnea causes. Although everyone knows that nasal CPAP is a great treatment, not many realize that it continues to be an extraordinary, elegant, experimental method. The experiment that we did on that first night in June 1980 has been, and is being used, by numerous research groups to unravel the mechanisms by which sleep apnea causes so many medical problems. There are few other diseases where the underlying key event (upper airway obstruction, in the case of sleep apnea) can be turned off and on at will. What this means is that measurements can be made (for example of blood vessel function, hormonal levels, or cellular function) before and after treatment in the same subjects, so that the precise effects of sleep apnea can be revealed. A large number of experimental studies using this method have now shown that sleep apnea activates the cellular pathways that cause atherosclerosis, hypertension, and many other pathological processes. These ongoing studies are truly remarkable.
Another pivotal moment for us is when we first tested nasal ventilation during sleep using the CPAP circuit and found that we could effectively manage patients with chronic respiratory failure using this system. Non-invasive ventilation is now used as the front line treatment for many patients with respiratory failure.
What do you see as the key development in the commercialization of CPAP?
We made and provided the masks and CPAP systems in our workshop so that by 1985 we had over 100 patients on