Advances in positive airway pressure treatment modalities for hypoventilation syndromes

The physiologic rationale for advanced PAP modalities is sound considering the complexity of sleep-disordered breathing in patients with hypoventilation syndromes. Various advanced PAP devices are available to assist breathing during sleep and wakefulness in patients with hypoventilation syndromes. Although such devices are increasingly used in clinical practice, the supporting clinical evidence warranting the use of such devices needs further study. Currently, there is an evolving body of literature that supports the beneficial effect of advanced PAP modalities on HR-QOL, physiologic endpoints, and even mortality. However, more comparative effectiveness research of such advanced PAP modality devices against conventional CPAP therapy in "realworld" situations and without the requirement of titration polysomnography need to be conducted. Moreover, there is much opportunity for further refining these devices, including the ability of the device to reliably monitor gas exchange, sleep- wakefulness state, and reducing variability in device efficacy owing to provider-selected device settings.