What is CPAP Belly Syndrome Vector

CPAP Belly Syndrome: An Overview (2024)

by | Updated: May 23, 2024

Continuous positive airway pressure (CPAP) therapy is a common and critical intervention for preterm neonates in the neonatal intensive care unit (NICU).

By providing a steady flow of air to the lungs, CPAP therapy helps maintain lung volume during breathing, crucial for babies who cannot breathe independently or who suffer from respiratory distress syndrome.

However, while CPAP is life-saving, it is not without complications.

One such complication is CPAP belly syndrome, a condition that has garnered attention for its impact on the abdominal girth and overall health of neonates undergoing CPAP therapy.

This article provides an overview of CPAP belly syndrome, exploring its definition, clinical implications, and the latest research on its management and outcomes.

What is CPAP Belly Syndrome?

CPAP belly syndrome is a condition observed in preterm neonates receiving CPAP therapy, marked by increased abdominal girth and potentially associated with delayed gastric emptying and increased gas in the gastrointestinal tract. This condition is not merely a superficial concern; it has significant clinical implications, including potential delays in enteral feeding and an increased risk of necrotizing enterocolitis (NEC), a serious intestinal disease.

The syndrome is particularly prevalent among the most vulnerable of neonates—those born prematurely and with lower birth weights.

CPAP belly syndrome vector illustration

Impact of CPAP Belly Syndrome

The impact of CPAP belly syndrome on neonatal care is multifaceted, influencing not only the physical health of preterm neonates but also the approach to their care and treatment. It complicates the management of feeding and respiratory support, with affected neonates often experiencing delayed gastric emptying.

This can prolong the need for parenteral nutrition, potentially increasing the risk of infections and other complications associated with intravenous feeding methods.

Moreover, the presence of CPAP belly syndrome is associated with an elevated risk of necrotizing enterocolitis (NEC), a serious gastrointestinal condition that can lead to significant morbidity and mortality among preterm infants.

The increased abdominal girth and gas pattern can also lead to diagnostic challenges, necessitating careful evaluation to distinguish it from other abdominal pathologies that may require surgical intervention.

The implications extend beyond the neonatal period, affecting the duration of hospital stay, the use of healthcare resources, and the overall trajectory of neonatal recovery.

Management and Treatment Approaches

Management and treatment of CPAP belly syndrome focus on alleviating symptoms, preventing complications, and ensuring the continuation of necessary CPAP therapy with minimal adverse effects.

Strategies include adjusting CPAP settings to the lowest effective pressure, optimizing feeding regimens to minimize gastrointestinal air intake, and using abdominal massage or positioning techniques to facilitate gas expulsion and reduce abdominal distension.

Close monitoring of abdominal girth and signs of gastrointestinal discomfort is essential, along with regular reassessment of the need for ongoing CPAP support.

In cases where CPAP belly syndrome is associated with significant complications, such as NEC, more aggressive interventions may be required.

What is Aerophagia?

Aerophagia refers to the condition of swallowing too much air, which can lead to discomfort and symptoms such as bloating, belching, abdominal pain, and sometimes gastrointestinal distress.

It often occurs during eating or drinking too quickly, chewing gum, smoking, or wearing loose dentures, leading to excessive air entering the digestive tract.

Aerophagia is related to CPAP belly syndrome as it involves the involuntary swallowing of air, which can occur during CPAP therapy. This can lead to the accumulation of air in the gastrointestinal tract, contributing to the symptoms observed in CPAP belly syndrome, such as increased abdominal girth and discomfort.

Essentially, the mechanics of CPAP therapy can exacerbate or lead to aerophagia, thereby increasing the risk of developing CPAP belly syndrome.

CPAP Belly Syndrome in Adults

CPAP belly syndrome is predominantly discussed in the context of neonatal care, with little direct reference to its occurrence in adults. However, the underlying mechanism—air swallowing (aerophagia) induced by CPAP therapy—can affect adults using CPAP for sleep apnea.

CPAP therapy is widely used to treat obstructive sleep apnea (OSA), a condition where the airway collapses or becomes blocked during sleep.

While CPAP therapy is effective in preventing airway collapse and improving sleep quality, it can sometimes lead to side effects, one of which is CPAP belly syndrome.

CPAP therapy leads to the ingestion of air. This can inadvertently cause the stomach to fill with air, leading to discomforts such as bloating, increased gas, burping, stomach distension, and in some cases, abdominal pain or discomfort.

Note: This condition is more likely to occur in CPAP users when the air pressure settings are too high, or if the patient has difficulty adjusting to the therapy and swallows air during the night.


Symptoms of CPAP belly syndrome in adults can include:

  • Bloating
  • Gas
  • Burping
  • Abdominal discomfort or pain
  • Distension of the stomach


Management strategies for CPAP Belly Syndrome focus on adjusting the CPAP settings to minimize air swallowing.

This can include:

  • Adjusting the CPAP machine’s air pressure settings, either by lowering the overall pressure or using machines with features like pressure relief during exhalation.
  • Changing the mask type or fit to ensure it is comfortable and reduces the likelihood of opening the mouth (and thus swallowing air) during sleep.
  • Consulting with a healthcare provider or sleep specialist to evaluate the need for further adjustments in therapy or exploring alternative treatments for sleep apnea.

Individuals experiencing symptoms of CPAP belly syndrome should consult with their healthcare provider or a sleep specialist.

These professionals can help determine the cause of the symptoms and make necessary adjustments to the CPAP therapy or explore other treatment options to ensure both effective management of sleep apnea and minimization of discomfort from therapy-related side effects.

FAQs About CPAP Belly Syndrome

Can CPAP Cause Abdominal Bloating?

Yes, CPAP therapy can cause abdominal bloating in some individuals. This condition, often referred to as CPAP belly syndrome, occurs when the user swallows air during sleep, a condition known as aerophagia.

This swallowed air can fill the stomach, leading to bloating, gas, and discomfort. It’s more likely to happen if the CPAP machine’s air pressure is too high or if the mask fit is not optimal, causing the user to swallow air.

How to Get Rid of CPAP Belly?

To alleviate CPAP belly, consider the following steps:

  • Adjust the CPAP Settings: Lowering the air pressure or using a machine with an auto-adjusting pressure setting can help reduce the amount of air swallowed.
  • Change the Mask Type or Fit: Ensure the mask fits well and is comfortable. A different style of mask might prevent air swallowing.
  • Consult with a Specialist: A sleep specialist can offer personalized adjustments to your CPAP setup or suggest alternatives to CPAP therapy if necessary.
  • Use CPAP Accessories: Products like CPAP pillows can enhance comfort and positioning, potentially reducing the likelihood of swallowing air.

Does CPAP Cause Weight Gain?

There is no direct evidence to suggest that CPAP therapy causes weight gain. In fact, effective treatment of sleep apnea with CPAP can lead to an overall improvement in sleep quality and energy levels, potentially facilitating weight loss or maintenance.

However, some individuals might experience changes in appetite or metabolism as their sleep patterns normalize. It’s important to maintain a healthy lifestyle, including a balanced diet and regular exercise while undergoing CPAP therapy.

If weight gain is noticed after starting CPAP, consulting with a healthcare provider is recommended to address potential causes and solutions.

Does Sleep Apnea Cause Belly Fat?

Sleep apnea itself can be associated with weight gain and an increased risk of obesity, which includes an accumulation of belly fat.

The relationship between sleep apnea and belly fat is complex and involves several factors, including hormonal imbalances, decreased energy levels, and changes in metabolism.

Poor sleep quality and frequent awakenings associated with sleep apnea can lead to increased stress hormones like cortisol, which may promote fat accumulation in the abdominal area.

Furthermore, the fatigue and sleepiness resulting from disrupted sleep can reduce physical activity levels and contribute to weight gain.

Addressing sleep apnea through CPAP therapy and lifestyle changes can help improve sleep quality and may have a positive impact on weight management.

Can CPAP Cause Gastritis?

CPAP therapy is not directly associated with causing gastritis, which is the inflammation of the stomach lining.

However, CPAP users who experience aerophagia, or the swallowing of air, may report symptoms similar to those of gastritis, such as abdominal discomfort, bloating, and indigestion.

These symptoms result from the air entering the stomach rather than the airway, leading to discomfort but not inflammation of the stomach lining.

If you have pre-existing gastritis, using a CPAP machine might exacerbate the sensation of bloating or discomfort, but it does not cause the condition.

If symptoms persist, it’s advisable to consult a healthcare provider for appropriate adjustments to CPAP settings or for alternative treatment options.

How Do CPAP Machines Cause Aerophagia?

CPAP machines cause aerophagia by forcing air into the airway to keep it open, which can lead to excess air entering the stomach and gastrointestinal tract.

This happens especially if the mask does not fit properly, the pressure settings are too high, or the user breathes through the mouth.

How Long Does Aerophagia from CPAP Last?

Aerophagia from CPAP therapy can vary in duration depending on several factors, including the individual’s adjustment to the CPAP machine, the appropriateness of the air pressure settings, and the fit of the mask.

For many users, symptoms of aerophagia diminish as they become more accustomed to the therapy and as adjustments are made to optimize the treatment.

This adjustment period can last from a few days to a few weeks. In cases where aerophagia persists, it’s important to consult with a healthcare provider or sleep specialist.

They can help by adjusting the CPAP machine’s settings, changing the mask, or exploring other interventions to reduce or eliminate the swallowing of air during therapy.

What Happens if You Get Too Much Air From CPAP?

Getting too much air from a CPAP machine can lead to several uncomfortable symptoms. These include bloating, gas, abdominal discomfort, and in some cases, increased burping or belching.

Excessive air can cause the stomach and intestines to distend, leading to discomfort and potentially disrupting sleep. In severe cases, it might also lead to pain or discomfort in the chest due to air pressure changes.

What Does Trapped Air in the Esophagus Feel Like?

Trapped air in the esophagus, often a result of aerophagia or swallowing air, can cause discomfort or a sensation of fullness in the chest or throat.

Symptoms might include burping, belching, bloating, and sometimes pain or discomfort in the chest area. This sensation can be mistaken for heart-related discomfort but is typically related to the gastrointestinal system.

People might also experience a feeling of an air bubble being stuck in their chest or throat, which can lead to discomfort until the air is expelled through burping.

Managing swallowing air involves addressing the underlying cause, such as adjusting eating habits, reducing stress, or, in the context of CPAP use, adjusting the machine’s settings.

How Does a CPAP Machine Work to Treat Sleep Apnea?

A CPAP machine works by delivering a continuous stream of pressurized air through a mask to the user’s airways during sleep.

This pressurized air keeps the throat muscles from collapsing, ensuring the airway remains open and preventing apnea episodes, which are pauses in breathing.

By maintaining an open airway, CPAP therapy helps to eliminate snoring and improves the quality of sleep for individuals with obstructive sleep apnea (OSA).

The machine typically includes a motor, a hose, and a mask. The motor draws in air from the room, pressurizes it, and delivers it at a prescribed pressure setting through the hose to the mask.

The user wears the mask over the nose, mouth, or both, allowing the pressurized air to flow freely into the airways, facilitating normal breathing patterns during sleep and significantly reducing the health risks associated with OSA.

Is CPAP Aerophagia Dangerous?

CPAP aerophagia, where users swallow air during CPAP therapy leading to discomfort like bloating and gas, is generally not considered dangerous. It can cause discomfort and disrupt sleep, but it doesn’t pose a serious health risk.

If symptoms are severe or persistent, consulting a healthcare provider is advised to adjust therapy settings or explore other solutions.

Final Thoughts

CPAP belly syndrome, though primarily associated with neonatal care, presents a complex challenge that spans across age groups, including adults using CPAP therapy.

This condition underscores the delicate balance required in managing respiratory support systems, highlighting the need for continuous research, refined diagnostic criteria, and innovative treatment strategies.

As our understanding of CPAP therapy evolves, so too will our ability to mitigate its impacts, improving the quality of care for all individuals reliant on this form of breathing support.

John Landry, BS, RRT

Written by:

John Landry, BS, RRT

John Landry is a registered respiratory therapist from Memphis, TN, and has a bachelor's degree in kinesiology. He enjoys using evidence-based research to help others breathe easier and live a healthier life.


  • Jaile JC, Levin T, Wung JT, Abramson SJ, Ruzal-Shapiro C, Berdon WE. Benign gaseous distension of the bowel in premature infants treated with nasal continuous airway pressure: a study of contributing factors. AJR Am J Roentgenol. 1992.
  • Bredenoord AJ, Weusten BL, Sifrim D, Timmer R, Smout AJ. Aerophagia, gastric, and supragastric belching: a study using intraluminal electrical impedance monitoring. Gut. 2004.

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