Research Article Open Access Antonello et al., J Gen Pract 2013, 1:2 DOI: 10.4172/2329-9126.1000110 Review Article Open Access Volume 1 • Issue 2 • 1000110 J Gen Pract ISSN: 2329-9126 JGPR, an open access journal Journal of General Practice J o u r n a l o f G e n e r a l P r a c t i c e ISSN: 2329-9126 Keywords: Sleep-related respiratory disorders; Non-invasive ventilation; Continuous positive airway pressure; Bilevel positive airway pressure Introduction Noninvasive mechanical ventilation (NIV) was originally used in patients with acute respiratory compromises or exacerbations of chronic respiratory diseases, as an alternative to the endotracheal tube. Over the last thirty years NIV has been also used during the night in patients with stable chronic lung disease such as obstructive sleep apnea, the overlap syndrome (COPD and obstructive sleep apnea), neuromuscular disorders, obesity-hypoventilation syndrome, and in other conditions such as sleep disorders associated with congestive heart failure (Cheyne-Stokes respiration) [1]. In this review we discuss the diferent types of NIV, the specifc conditions in which they can be used and the indications, recommendations and evidence supporting the efcacy of NIV. Specifc Conditions for Non-Invasive Ventilation Obstructive sleep apnea-hypopnea syndrome (OSA) Te obstructive apnea-hypopnea syndrome has an incidence of 2% in women and 4% in men. It is characterized by recurrent episodes of partial (hypopnea) or complete (apnea), obstruction of the upper airway during sleep, and is associated with episodes of arousal and/or oxyhemoglobin desaturation [2,3]. Symptoms of the syndrome are reported in Table 1. Te pathophysiology of obstructive sleep apnea is still controversial. Obesity, the classic hallmark in OSA, is not well understood as a cause leading to obstruction of the upper airways. Possible hypotheses include adipose tissue infarction of the tongue and/or the dilator muscles of the pharynx. Te upper airway becomes less efcient, reducing oropharyngeal space especially at the end of exhalation. As a result, at the beginning of the next inspiration the dilator muscles of the pharynx (see genioglossus) should produce a greater contraction to *Corresponding author: Nicolini Antonello, Respiratory Diseases Unit, Hospital of Sestri Levante, Via Terzi 43, 16039 Sestri Levante, Italy, Tel: 0185-329145; Fax: 0185329935; E-mail: antonello.nicolini@fastwebnet.it Received April 30, 2013; Accepted June 10, 2013; Published June 15, 2013 Citation: Antonello N, Paolo B, Cornelius B, Gianluca F, Agata L, et al. (2013) Non-Invasive Ventilation in the Treatment of Sleep-Related Breathing Disorders: Concise Clinical Review. J Gen Pract 1: 110. doi: 10.4172/2329-9126.1000110 Copyright: © 2013 Antonello N, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Abstract Non-invasive mechanical ventilation (NIV) was originally used in patients with acute respiratory compromises or exacerbations of chronic respiratory diseases, as an alternative to the endotracheal tube. Over the last thirty years NPPV has been also used during the night in patients with stable chronic lung disease such as obstructive sleep apnea, the overlap syndrome (COPD and obstructive sleep apnea), neuromuscular disorders, obesity-hypoventilation syndrome, and in other conditions such as sleep disorders associated with congestive heart failure (Cheyne-Stokes respiration). In this review we discuss the different types of NPPV, the specifc conditions in which they can be used and the indications, recommendations and evidence supporting the effcacy of NIV. Obstructive sleep apnea syndrome (OSA) is characterized commonly by instability of upper airway during sleep, reduction or elimination of airfow, daytime hypersomnolence, sleep disruption. It is a risk factor for cardiovascular and cerebrovascular disorders including hypertension, myocardial infarction and stroke. Optimizing patient acceptance and adherence to non-invasive ventilation treatment is challenging. The treatment of sleep-related disorders is a life-threatening condition. The optimal level of treatment should be determinate in a sleep laboratory. Side effects directly affecting the patient’s adherence to treatment are known. The most common are nasopharyngeal symptoms including increased congestion and rhinorrhea; these effects are related to reduced humidity of inspired gas. Humidifcation of delivered gas may improve these symptoms. Sleep specialists should review the results of objective testing with the patient. Education of the patient concerning the nature of the disorder and treatment options is important. General education on the impact of weight loss, sleep position, alcohol avoidance, risk factor modifcation and medication effects should be discussed. The patient should be counseled on the risks and management of drowsy driving. Patient education should optimally be delivered as a part of a multidisciplinary chronic disease management team. Non-Invasive Ventilation in the Treatment of Sleep-Related Breathing Disorders: Concise Clinical Review Nicolini Antonello 1 *, Banf Paolo 2 , Barlascini Cornelius 3 , Ferraioli Gianluca 4 , Lax Agata 2 and Grecchi Bruna 5 1 Respiratory Diseases Unit, Hospital of Sestri Levante, Italy 2 Neuromuscular Diseases Unit, Don Gnocchi Foundation, Milan, Italy 3 Forensic Medicine, ASL4 Chiavarese, Chiavari, Italy 4 Emergency Department, ASL4 Chiavarese, Chiavari, Italy 5 Rehabilitation Department, ASL4 Chiavarese, Chiavari, Italy Snore Nocturia Unrefreshing sleep Choking Daytime sleepiness Decreased libido Morning headache Enuresis Table 1: Typical symptoms of osas.