Tratamiento de la apnea del sueño: diferencias entre CPAP y BiPAP

Si te han diagnosticado apnea del sueño, es probable que ya te hayan hablado de las posibles opciones de tratamiento. Pero incluso si ya las conoces, quizás quieras saber la diferencia entre dos opciones un tanto similares: CPAP y BiPAP.

El tratamiento estándar para la apnea del sueño es el uso de una máquina que proporciona apoyo para mantener abiertas las vías respiratorias mientras el paciente duerme. De acuerdo a sus características, en inglés esta máquina puede llamarse Continuous Positive Airway Pressure (CPAP, en castellano Presión Positiva Continua de las Vías Respiratorias) o Bilevel Positive Airway Pressure (BiPAP, Presión Positiva de las Vías Respiratorias de Dos Niveles).

La principal diferencia entre ambas modalidades es el tipo de presión positiva que se aplica a las vías aéreas del paciente: única en la CPAP y doble en la BiPAP (Inspiratoria -IPAP- y espiratoria -EPAP-). Aunque también existen otros detalles particulares que deben mencionarse:

CPAP

Con este sistema se proporciona un flujo constante de aire a través de una máscara facial. La presión de este aire se determina en función de las necesidades del paciente y tiene el objetivo de prevenir tanto la apnea como los ronquidos. Es el tratamiento de elección y el más efectivo, entre los no quirúrgicos, para los casos más severos de Síndrome de Apnea del Sueño. El porcentaje de pacientes que resuelven su problema mediante la CPAP es muy elevado (superior al 90%) y la mejoría clínica se observa desde los primeros días de uso.

Para determinar la presión más adecuada a cada sujeto, debe realizarse una titulación de presión mediante una polisomnografía nocturna. El estudio consiste en ir aumentando lentamente la presión a la vez que se monitorea el resto de parámetros, para conseguir la mínima presión efectiva que garantice la desaparición de los eventos respiratorios y una buena calidad de sueño. Se emplea la misma técnica y preparación que para la polisomnografía, siendo aplicables las recomendaciones para esta.

Distintas investigaciones han demostrado que la terapia CPAP ayuda a disminuir la somnolencia diurna, baja la presión arterial y reduce el riesgo de problemas cardíacos en los pacientes con historial de enfermedad de las arterias coronarias. Las máquinas CPAP son más eficaces cuando se usan cada noche sin interrupción.

Hay algunos riesgos y efectos secundarios asociados con la terapia CPAP (sequedad o congestión nasal, dolores de garganta o de cabeza, entre otros) , pero la mayoría se encuentran en las etapas iniciales de tratamiento y empiezan a disminuir a medida que este continúa.

BiPAP

Una máquina BiPAP incluye un componente que genera presión, algunos tubos y una máscara que se coloca al paciente sobre su cara cuando se va a la cama. Durante el sueño, la máquina utiliza la presión para mover el aire a los pulmones y mantenerlos abiertos para que el paciente pueda utilizar mejor el oxígeno tomado.

El usuario típico de una máquina BiPAP es un paciente que ha utilizado una máquina CPAP durante la noche, pero necesita más ayuda para respirar o una mayor comodidad que la que proporciona una CPAP. La principal diferencia entre ambas máquinas es que, mientras la CPAP se centra en la presión de inhalación y puede representar un desafío para respirar en contra de esa presión, la BiPAP ofrece más ajuste tanto para inspirar como para espirar, de forma que el paciente se siente más cómodo.

Al igual que en el caso del CPAP, antes de utilizar un aparto BiPAP se realizan algunos tests para determinar su necesidad, idoneidad y configuración de presión. Algunos de los más habituales son la medida del oxígeno y dióxido de carbono sanguíneos y la frecuencia respiratoria. Otras situaciones, por ejemplo la apnea del sueño, requieren pruebas especiales tal como ya se ha indicado.

Hay una buena variedad de máquinas BiPAP en el mercado. Algunas se adaptan automáticamente mientras el paciente duerme. Otras tienen como complemento un humidificador para ayudar al paciente con la sequedad nasal y con otros síntomas de garganta, que pueden ser causados por el aire que se mueve desde estas máquinas. Y también existen opciones que ofrecen un seguimiento digital de los datos de respiración y alarmas en caso de fallo de la máquina. Lo importante, en estos casos, es la consulta previa con un médico y luego contactar con un proveedor o asesor de ventas calificado.

Fuentes: apneas.info, iis.es, curiosoando.com, elenfermerodelpendiente.com

 

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