Can Intensive Support Improve Continuous Positive Airway Pressure Use in Patients with the Sleep Apnea/Hypopnea Syndrome?

Abstract

Continuous positive airway pressure (CPAP) therapy is widely prescribed for patients with the sleep apnea/hypopnea syndrome (SAHS), but the use of CPAP for such patients is disappointingly low. We postulated that providing intensive educational programs and nursing support to SAHS patients might improve CPAP use and outcomes. We also examined the hypothesis that CPAP use would be greater among patients who had initiated their own referral than among those asked to seek help by a partner. We randomized 80 consecutive, new patients with SAHS to receive either usual support or additional nursing input including CPAP education at home and involving their partners, a 3-night trial of CPAP in our institution's sleep center, and additional home visits once they had begun CPAP. The primary outcome variable was objective CPAP use; symptoms, mood, and cognitive function were also assessed after 6 mo. CPAP use over 6 mo was greater (p = 0.003) among patients receiving intensive than among those receiving standard support (5.4 +/- 0.3 versus 3.9 +/- 0. 4 h/night [mean +/- SEM]), with greater improvements (p < 0.05) in SAHS symptoms, mood, and reaction time in the intensively supported group. CPAP use was greater (p = 0.002) among patients who initiated their own referrals. CPAP use and outcomes of therapy can be improved by provision of a nurse-led intensive CPAP education and support program. CPAP use is lower among patients whose partners ask them to seek treatment.

Therapy with nCPAP: incomplete elimination of Sleep Related Breathing Disorder

“…A study by ENGLEMAN et al [19] reported a low (4.30.6 h) CPAP run-time in users without reported therapy related problems and an even lower one (2.80.6 h) in those complaining of side-effects. Additionally, a recent study reported daily CPAP use (3.90.4) at similar levels to the data produced in this study for patients who received standard support for nCPAP therapy [20]. Compliance with CPAP therapy was related to the amount of OSA activity, the severity of daytime sleepiness, as well as the diagnostic follow-up procedure used.…”

“…In patients with sleep laboratory follow-up at 9 months, residual RDI with CPAP applied was almost identical in acceptors and non-acceptors, 1 (24) Rejected CPAP immediately after CPAP titration (27) With CPAP effectiveness data (20) With missing data (4) Accepting CPAP therapy with 9 month follow-up (acceptors (74))…”

Long-term treatment with continuous positive airway pressure improves quality of life in obstructive sleep apnoea syndrome

“…A recently published study demonstrated that the relief of sleepiness and other OSAS-related clinical symptoms and improvement in perceived health status was much greater in patients receiving conservative and CPAP treatment compared with those only receiving conservative treatment, even after 3 months of treatment [17]. Another study in 80 consecutive patients showed that CPAP use over 6 months was greater among patients receiving intensive than among those receiving standard support, with greater improvements in OSAS symptoms, mood, and reaction time in the intensively supported group [27]. Furthermore, a retrospective French study demonstrated that patients who continued CPAP treatment for >6 months had a relatively good perception of their health.…”

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

“…[10][11][12][13][14][15][16][17][18][19][20][21][22][23] Improvements in nCPAP technology, in particular the introduction of automatic adjustments of the nCPAP pressure throughout the night (auto-CPAP), [24][25][26][27][28][29] and other attempts to enhance acceptance and compliance (positive reinforcement, psychological/educational interventions, heated humidiWcation) have been introduced. [30][31][32][33][34] We were interested to see if these actions have led to better acceptance, adherence and long-term compliance as compared to earlier reported data. We acquired data on (long-term) compliance and therapy failure.…”