Acceptance and long-term compliance of nCPAP in obstructive sleep apnea

Richard, Wietske; Venker, Jantine; Herder, Cindy den; Kox, Dennis; Berg, Bob van den; Laman, Martin; Tinteren, Harm van; Vries, Nico de

doi:10.1007/s00405-007-0311-3

Cited by 90 publications

(60 citation statements)

References 46 publications

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“…However, while the addition of humidification has been shown to improve compliance with CPAP in some studies (25), this has not been a universal finding (26). Similarly, although it might be expected that auto-CPAP would enhance patient comfort and improve compliance, Richard et al (27) reported that 25% of patients in their series discontinued CPAP and that there were no significant differences between the fixed pressure and auto-CPAP users.…”

Section: Discussionmentioning

confidence: 89%

Long-Term Compliance with Continuous Positive Airway Pressure in Patients with Obstructive Sleep Apnea

Wolkove

Baltzan

Kamel

et al. 2008

Canadian Respiratory Journal

177

106

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BACKGROUND: Continuous positive airway pressure (CPAP) is an effective treatment for obstructive sleep apnea (OSA). However, compliance is a significant problem and has been incompletely assessed in long-term studies.OBJECTIVE: To assess the long-term compliance of OSA patients with CPAP therapy.SUBJECTS: Eighty patients who had had a diagnosis of OSA at least four years previously and received a written prescription for CPAP were evaluated.METHODS: Subjects were identified by reviewing sleep laboratory records. Participants were contacted by telephone and were asked to quantitate their CPAP use (hours per night, nights per week) and to evaluate whether there had been improvement in symptoms. Those who commenced but subsequently abandoned therapy and those who never initiated treatment were questioned about their reasons for noncompliance.RESULTS: Patient demographics included mean (± SD) age (58±11 years), male sex (70 of 80 patients [88%]) and mean apnea-hypopnea index (70±44 events/h). At the time of the interview (64.0±3.7 months after diagnosis), 43 of 80 patients (54%) were still using CPAP and most reported an improvement in symptoms. Twelve of 80 patients (15%) had abandoned CPAP after using it for 10.1±15.5 months, and 25 of 80 patients (31%) had never commenced therapy after initial diagnosis and CPAP titration. Analysis of scores reflecting initial patient sleepiness revealed a significant association of this symptom with subsequent CPAP compliance.CONCLUSION: Although many patients with OSA derive subjective benefit from, and adhere to treatment with CPAP, a significant proportion of those so diagnosed either do not initiate or eventually abandon therapy. Initial experience with CPAP appears to be important, reinforcing the need for early education and support in these patients.

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Section: Discussionmentioning

confidence: 89%

Long-Term Compliance with Continuous Positive Airway Pressure in Patients with Obstructive Sleep Apnea

Wolkove

Baltzan

Kamel

et al. 2008

Canadian Respiratory Journal

177

106

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“…2,3 Despite the low morbidity and high effectiveness of CPAP, long-term adherence and acceptance rates are suboptimal and necessitate consideration of alternative treatment options in many patients. [4][5][6] A variety of interface-related or pressure-related side effects as well as psychosocial barriers frequently preclude…”

Section: Introductionmentioning

confidence: 99%

Upper Airway Stimulation for Obstructive Sleep Apnea: Self-Reported Outcomes at 24 Months

Soose

Woodson

Gillespie

et al. 2016

Journal of Clinical Sleep Medicine

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Objectives:To evaluate the long-term (24-mo) effect of cranial nerve upper airway stimulation (UAS) therapy on patient-centered obstructive sleep apnea (OSA) outcome measures. Methods: Prospective, multicenter, cohort study of 126 patients with moderate to severe OSA who had difficulty adhering to positive pressure therapy and received the surgically implanted UAS system. Outcomes were measured at baseline and postoperatively at 12 mo and 24 mo, and included self-and bedpartner-report of snoring intensity, Epworth Sleepiness Scale (ESS), and Functional Outcomes of Sleep Questionnaire (FOSQ). Additional analysis included FOSQ subscales, FOSQ-10, and treatment effect size. Results: Significant improvement in mean FOSQ score was observed from baseline (14.3) to 12 mo (17.3), and the effect was maintained at 24 mo (17.2). Similar improvements and maintenance of effect were seen with all FOSQ subscales and FOSQ-10. Subjective daytime sleepiness, as measured by mean ESS, improved significantly from baseline (11.6) to 12 mo (7.0) and 24 mo (7.1). Self-reported snoring severity showed increased percentage of "no" or "soft" snoring from 22% at baseline to 88% at 12 mo and 91% at 24 mo. UAS demonstrated large effect size (> 0.8) at 12 and 24 mo for overall ESS and FOSQ measures, and the effect size compared favorably to previously published effect size with other sleep apnea treatments. Conclusions: In a selected group of patients with moderate to severe OSA and body mass index ≤ 32 kg/m2, hypoglossal cranial nerve stimulation therapy can provide significant improvement in important sleep related quality-of-life outcome measures and the effect is maintained across a 2-y follow-up period. I NTRO DUCTI O NPatients suffering from moderate to severe obstructive sleep apnea (OSA) commonly report symptoms consistent with excessive daytime sleepiness, neurocognitive dysfunction, and impaired quality of life.1 Although the underlying pathophysiologic mechanisms of OSA are complex, multifactorial, and variable among patients, the goals of any longitudinal care model are generally consistent across all patients and fall into two categories: (1) to improve sleep related symptoms and quality-of-life measures, and (2) to reduce cardiovascular and related health risks.Continuous positive airway pressure (CPAP) therapy has a wealth of data on safely and effectively accomplishing these goals and remains the standard first-line therapy.2,3 Despite the low morbidity and high effectiveness of CPAP, long-term adherence and acceptance rates are suboptimal and necessitate consideration of alternative treatment options in many patients. adequate use. Recent multicenter trials reported 6-mo adherence rates of only 39% to 50%. 5,6 A universally accepted second-line therapy does not exist; however, oral appliance BRIEF SUMMARY Current Knowledge/Study Rationale: Hypoglossal cranial nerve stimulation therapy consists of a surgically implantable and medically titratable second-line treatment option for obstructive sleep apnea (OSA), and was previous...

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“…CPAP is the most effective treatment for patients with severe OSAS; however, treatment effectiveness is limited by compliance with longterm treatment [7,8,18]. Maintaining this compliance requires intensive education, motivational enhancement and support [19,20].…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, patients with untreated moderate and severe OSAS run an increased risk of cardiovascular morbidity [4][5][6]. CPAP is the most effective treatment for patients with severe OSAS; however, 29%-83% of patients use CPAP for less than 4 hours a night due to the practical difficulties of using the CPAP device [7]. Wolkove et al found significant problems with CPAP compliance in long-term treatment.…”

Section: Introductionmentioning

confidence: 99%

Reduced Apnea-Hypopnea Index in Patients with Severe Sleep Apnea Syndrome as Determined by Cervical Collar and Mandibular Advancement Device Combination Therapy

Delijaj¹,

Levin²,

Lindberg³

et al. 2016

J Sleep Disord Ther

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Study Objectives: In patients with severe obstructive sleep apnea syndrome (OSAS), continuous positive airway pressure (CPAP) is first-line therapy. Compliance to CPAP is sometimes a problem, and mandibular advancement device (MAD) is then an alternative. However, this alternative is often not effective. It was hypothesized that patients suffering from OSAS would have a freer airway, resulting in a decreased apnea-hypopnea index (AHI), through use of a cervical collar (CC) to extend the neck. To study the effect of this new therapy, a randomized crossover study was conducted to compare MAD monotherapy with CC/MAD combination therapy.Methods: Eight patients with severe OSAS (AHI>30) who had ceased to use CPAP were enrolled in the randomized crossover study. Four patients started with MAD and four with CC/MAD for one week followed by a wash-out period and then cross-over. Polygraphic sleep recordings were performed at baseline and after each therapy. Results:The baseline AHI was 51.5 ± 22.5. AHI was reduced to 30.4 ± 23.2 through MAD monotherapy, and to 14.9 ± 10.2 through CC/MAD combination therapy. The effect of the combination therapy was statistically significantly (p=0.018) better than that of the monotherapy. Four patients were achieved an AHI<10/h through use of the combination therapy. Concusions:The study showed a significant reduction in AHI scores in patients with severe OSAS through use of the CC/MAD combination therapy as compared to the MAD monotherapy. This first report indicates a new possibility for treating severe OSAS in non-compliant CPAP users.

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Acceptance and long-term compliance of nCPAP in obstructive sleep apnea

Cited by 90 publications

References 46 publications

Long-Term Compliance with Continuous Positive Airway Pressure in Patients with Obstructive Sleep Apnea

Long-Term Compliance with Continuous Positive Airway Pressure in Patients with Obstructive Sleep Apnea

Upper Airway Stimulation for Obstructive Sleep Apnea: Self-Reported Outcomes at 24 Months

Reduced Apnea-Hypopnea Index in Patients with Severe Sleep Apnea Syndrome as Determined by Cervical Collar and Mandibular Advancement Device Combination Therapy

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