Regardless of the mechanism, nasal CPAP has been documented to be effective in eliminating both mixed and obstructive apneas (15). Some central apneas (see Chapter 19), particularly those observed in patients with predominantly obstructive events, are also eliminated by nasal CPAP (15). Clearly, some central apneas are associated with increased upper airway resistance and it could be argued that it is better to consider apnea classification as being CPAP responsive or CPAP nonresponsive. CPAP may also be effective in controlling central apneas associated with cardiac failure (see section: Continuous Positive Airway Pressure and Cardiac Failure). In some instances, CPAP alone will not control severe mixed central and obstructive apneas and adjunctive entrainment of low concentrations of carbon dioxide, with CPAP, or the use of other noninvasive ventilatory techniques, may further reduce the respiratory disturbance index (RDI) in such individuals (16).
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