Acceptance of CPAP Therapy for Sleep Apnea

137

Correct assessment of the overall treatment effectiveness requires knowledge about therapy compliance and efficacy. This study aimed to determine overall long-term apnoea alleviation after continuous positive airway pressure (CPAP) in a complete sleep laboratory cohort.Out of 209 consecutive CPAP candidates (mean age 5712 yrs, body mass index (BMI) 30.05.1 kg . m 2 , respiratory disturbance index (RDI) 32.929 h), follow-up treatment was performed in 149 of them at 9, 18 and 30 months after CPAP prescription. Compliance with CPAP (machine run time/days CPAP available) was adjusted for the individual subjective sleep-time. Apnoea alleviation was defined as adjusted compliance multiplied by the CPAP effect (RDI with CPAP applied), remaining RDI was calculated.The baseline RDI, age or BMI in 75 patients, who did not tolerate nasal continuous positive airway pressure (nCPAP), did not differ from those accepting CPAP (acceptors, n=74). In acceptors at 9 months follow-up RDI with CPAP applied was 1.42.6 (CPAP effect, n=66), mean CPAP use was 3.62.5 . 24 h -1 (n=68), mean apnoea alleviation was 52.432.0% (range 1±100%, n=47), the average remaining wholenight RDI was 17.826. At 9, 18 and 30 months (n=47), the mean daily CPAP use increased from 3.62.5 h to 4.12.5 h and 4.42.4 h (p<0.01).Effectiveness of continuous positive airway pressure is potentially high but acceptance was low. When accounting for sleep-time, its actual effect and use, only 50% adjusted continuous positive airway pressure effectiveness was observed. Eur Respir J 2000; 16: 921±927.

Section: Discussionsupporting

confidence: 93%

Therapy with nCPAP: incomplete elimination of Sleep Related Breathing Disorder

Grote¹,

Hedner²,

Grunstein³

et al. 2000

137

“…Earlier studies which relied on patientadministered questionnaires were unable to demonstrate a correlation between the prevalence of nasal symptoms and the rates of nCPAP acceptance [26,28]. The presented results are in keeping with these findings.…”

Section: Discussionsupporting

confidence: 89%

“…However, the focus of the present study was to address the effects of humidification during nCPAP therapy initiation; the motivation being that this strategy may potentially reduce the reported 20-42% refusal rate that follows the first night titration, for reasons relating to nasal and mask intolerance [5,26,27]. Furthermore, anecdotal evidence suggests that subsequent trials with nCPAP following an unsuccessful first attempt often lead to further failure [26]. Finally, it is possible that the scales and the questionnaire used may lack sensitivity.…”

Section: Discussionmentioning

confidence: 99%

“…The presented results are in keeping with these findings. However, patients who refused or eventually stopped therapy were reported to give nasal symptoms, along with other reasons, as a cause for treatment discontinuation [26,27]. Without the consideration of potential confounders, such as OSAS severity, comorbidity, co-interventions, and patient's psychosocial background, this may have led to conclusions that overestimated the causal role of nasal symptoms in the refusal of therapy.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Use of heated humidification during nasal CPAP titration in obstructive sleep apnoea syndrome

Duong

Jayaram

Camfferman³

et al. 2005

Nasal symptoms associated with the use of nasal continuous positive airway pressure (nCPAP) in obstructive sleep apnoea (OSA) can adversely impact on patients' tolerance, acceptance and adherence to nCPAP therapy. Regular use of heated humidification is effective in alleviating these symptoms and improve patient comfort.In a randomised, parallel, double-blinded, controlled study, the present authors examined the use of heated humidification during a single night laboratory nCPAP titration in untreated OSA patients and its effect on nasal symptoms, nasal airway resistance (NAR), effective pressure and treatment tolerability and acceptance.Baseline characteristics of subjects (n570) receiving placebo and humidification were (mean¡SEM): age 51.2¡2.2 versus 50.6¡1.6 yrs; body mass index 33.6¡0.9 versus 35.2¡0.9 kg?m significantly different between the groups. No difference was found in the frequency and severity of nasopharyngeal symptoms, therapeutic pressure and subjective response to nCPAP.In conclusion, heated humidification during the initial nasal continuous positive airway pressure titration offers no additional benefit in nasal physiology, symptoms or subjective response to nasal continuous positive airway pressure, and, therefore, should not be routinely recommended.

“…4) A significant number of CPAP-treated patients recovered their physiological nocturnal dipper pressure pattern. This interesting observation could be explained both by the normalisation of SDB after CPAP treatment, since Conversely, CPAP treatment was well tolerated in the present study (.70%), with tolerance figures similar to those reported for patients with SAHS [39]. No significant differences were observed in the characteristics of the two groups (i.e.…”

Section: Cpap Treatment In Dc-ht Ma Martínez-garcíasupporting

confidence: 85%

Positive effect of CPAP treatment on the control of difficult-to-treat hypertension

Martínez-García¹,

Gómez‐Aldaraví²,

Soler-Cataluña³

et al. 2007

The aim of the present study was to analyse the role of continuous positive airway pressure (CPAP) treatment in patients with difficult-to-control hypertension (DC-HT) and sleep apnoea.An Autoset TM (ResMed, Sydney, Australia) study was performed in 60 patients diagnosed with DC-HT based on two 24-h ambulatory blood pressure monitorisation (ABPM) studies. CPAP was offered to patients with an apnoea/hypopnoea index (AHI) o15 events?h -1 . After 3 months of treatment, repeat ABPM was performed to evaluate the effect of CPAP upon the blood pressure values.A total of 39 (65%) patients received CPAP treatment, but only 33 completed the study. The mean¡SD systolic and diastolic blood pressures (SBP and DBP, respectively) were 154.8¡14 and 90¡8.8 mmHg. Patients had a mean¡SD AHI of 37.7¡18.2 events?h -1. Only three patients presented a dipper nocturnal pressure pattern. CPAP treatment significantly reduced SBP (-5.2 mmHg), and particularly the nocturnal values (-6.1 mmHg), but not DBP. Considering only those patients who tolerated CPAP, the decrease in SBP was greater (-7.3 mmHg). Furthermore, CPAP treatment significantly increased the percentage of patients who recovered the dipper pattern (three (9.1%) out of 33 versus 12 (36.4%) out of 33).Continuous positive airway pressure treatment significantly reduces systolic blood pressure, particularly at night, and normalises the nocturnal pressure pattern in patients with difficult-tocontrol hypertension and sleep apnoea.