Am. J. Respir. Crit. Care Med., Vol 151, No. 5, May 1995, 1632-1634.
Ramp abuse. A novel form of patient noncompliance to administration of nasal continuous positive airway pressure for treatment of obstructive sleep apnea
MR Pressman, DD Peterson, TJ Meyer, JP Harkins and L Gurijala
Sleep Disorders Center, Lankenau Hospital and Medical Research Center, Wynnewood, Pennsylvania 19096-3498, USA.
Administration of nasal continuous positive airway pressure (NCPAP) is the
treatment of choice for most patients with obstructive sleep apnea. Many
patients experience side effects with NCPAP use, and the compliance rate is
reported to vary between 46-89%. The ramp is a device found on many NCPAP
machines that resets the pressure to 3 cm H2O and then slowly increases the
pressure to the prescribed pressure over a period of up to 45 min. The ramp
allows patients time to fall asleep before the higher and likely more
uncomfortable prescribed pressure is administered. We present a case in
which a patient's repeated remote-controlled activation of this ramping
feature severely limited effective therapy even when the NCPAP mask was
properly in place, the machine was on, and the patient was breathing
nasally.
