Clinical and Polysomnographic Predictors of Short-Term Continuous Positive Airway Pressure Compliance

Collen, Jacob; Lettieri, Christopher J.; Kelly, William F.; Roop, Stuart

doi:10.1378/chest.08-2182

Cited by 74 publications

(50 citation statements)

References 46 publications

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“…These findings should also be interpreted with caution given the compliance assessment period extended beyond eight months in only half of the data set and the standard deviations for the behavioral measures were large. Another limitation of this data set was the inability to determine if age, body mass index, or supine or nonspine OSA severity influenced short-and long-term utilization in a manner similar to its affect on CPAP adherence (Collen, Lettieri, Kelly, & Roop, 2009;Kohler, Smith, Tippett, & Stradling, 2010). Further investigations are needed to evaluate the influence of overall and nonsupine OSA severity and the propensity to sleep supine prior to initiating positional therapy on short-and long-term compliance and adaptation.…”

Section: Discussionmentioning

confidence: 99%

User Compliance and Behavioral Adaptation Associated With Supine Avoidance Therapy

Levendowski

Cunnington

Swieca

et al. 2016

Behavioral Sleep Medicine

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Section: Discussionmentioning

confidence: 99%

User Compliance and Behavioral Adaptation Associated With Supine Avoidance Therapy

Levendowski

Cunnington

Swieca

et al. 2016

Behavioral Sleep Medicine

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“…Lewis et al 42 also showed that those patients who reported problems on the first night of CPAP showed worse CPAP adherence. In support of the hypothesis that better sleep on the titration night predicts better adherence, Colleen et al 43 and Lettieri et al 37 showed that use of a sedative hypnotic on the titration study night was associated with longer TST and higher sleep efficiency on that night and was also a significant predictor of higher short-term CPAP adherence. These authors suggest that "medication use may improve the patients' overall experience in the sleep laboratory setting.…”

Section: 3839mentioning

confidence: 91%

Sleep Quality, Short-Term and Long-Term CPAP Adherence

Somiah

Taxin

Keating

et al. 2012

Journal of Clinical Sleep Medicine

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S C I E N T I F I C I N V E S T I G A T I O N SU ntreated obstructive sleep apnea/hypopnea syndrome (OSAHS) signifi cantly affects quality of life and cardiovascular/cerebrovascular morbidities and mortality.1-4 CPAP therapy has been shown to be effective in treating sleep disordered breathing (SDB) by reducing the apnea/hypopnea index (AHI) 5 and by reducing excessive daytime somnolence (EDS). 6Despite this, CPAP acceptance and adherence are disappointingly low. A signifi cant number of patients (ranging from 30% to 80% in various studies) demonstrate an average CPAP usage of less than 4 hours per night. 7,8 Several reviews have emphasized the need to identify patients who are at the greatest risk for non-adherence, with the goal of developing techniques to maximize overall adherence. 9,10Studies have suggested that CPAP adherence can be correlated to characteristics of patients at baseline, such as the severity of OSAHS, 11-13 the level of EDS, 14 and anatomical factors (smaller nasal cross-sectional area, reduced nasal volume, and high nasal resistance 15,16 ), but the strength of these correlations has been weak. Drake et al. showed that patients whose sleep effi ciency on the CPAP titration night improved most had the greatest CPAP compliance at 47 days.17 More recently, studies using social cognitive theory 18-20 and health BRIEF SUMMARYCurrent knowledge/Study Rationale: Despite its efficacy, adherence to CPAP therapy is highly variable amongst patients with obstructive sleep apnea with large numbers of patients demonstrating inadequate adherence to CPAP. The present study is aimed at identifying early predictors of CPAP adherence from variables obtained at the time of diagnosis and titration of CPAP, thereby providing potential for early intervention. Study Impact: Our data show that better sleep quality (greater % REM) was seen in patients with higher CPAP adherence and confi rm that long term adherence was largely predicted by short term adherence. This suggests that interventions that improve sleep during or prior to the CPAP titration study may be useful in improving CPAP adherence.

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“…CPAP use data were obtained from the patients' electronic records approximately 2.5 years after the OSA diagnosis and referral to the sleep clinic. CPAP use for more than 4 hours per night on 70% of days was considered to indicate compliance (22). DR/STDR was assessed using two-field 45-degree digital retinal images for each eye in accordance with the English national screening program guidelines (Table 1 OSA on the rate of progression of STDR, a longitudinal analysis using retinal images from one of the study centers was performed in 2014.…”

Section: Methodsmentioning

confidence: 99%

“…Data analysis was performed using IBM SPSS Statistics version 22 To assess whether OSA and/or hypoxemia measures were independently associated with STDR, advanced DR, and maculopathy, multiple logistic regression (forced entry method) was used, in which STDR, advanced DR, and maculopathy status, respectively, were the outcome measures and OSA and other possible confounders were the covariates. To assess the predictors of DR progression, multiple logistic regression was used with progression to maculopathy and progression to advanced DR as the outcomes and OSA and other confounders as the covariates (see the RESULTS section for a full list of the covariates).…”

Section: Methodsmentioning

confidence: 99%

Obstructive Sleep Apnea and Retinopathy in Patients with Type 2 Diabetes. A Longitudinal Study

Altaf

Dodson

Ali

et al. 2017

Am J Respir Crit Care Med

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Rationale: Obstructive sleep apnea (OSA) is associated with several pathophysiological deficits found in diabetic retinopathy (DR). Hence, it's plausible that OSA could play a role in the pathogenesis of sight-threatening DR (STDR).Objectives: To assess the relationship between OSA and DR in patients with type 2 diabetes and to assess whether OSA is associated with its progression.Methods: A longitudinal study was conducted in diabetes clinics within two U.K. hospitals. Patients known to have any respiratory disorder (including OSA) were excluded. DR was assessed using twofield 45-degree retinal images for each eye. OSA was assessed using a home-based multichannel cardiorespiratory device. Measurements and Main Results:A total of 230 patients were included. STDR and OSA prevalence rates were 36.1% and 63.9%, respectively. STDR prevalence was higher in patients with OSA than in those without OSA (42.9% vs. 24.1%; P = 0.004). After adjustment for confounders, OSA remained independently associated with STDR (odds ratio, 2.3; 95% confidence interval, 1.1-4.9; P = 0.04). After a median (interquartile range) follow-up of 43.0 (37.0-51.0) months, patients with OSA were more likely than patients without OSA to develop preproliferative/proliferative DR (18.4% vs. 6.1%; P = 0.02). After adjustment for confounders, OSA remained an independent predictor of progression to preproliferative/proliferative DR (odds ratio, 5.2; 95% CI confidence interval, 1.2-23.0; P = 0.03). Patients who received continuous positive airway pressure treatment were significantly less likely to develop preproliferative/proliferative DR.Conclusions: OSA is associated with STDR in patients with type 2 diabetes. OSA is an independent predictor for the progression to preproliferative/proliferative DR. Continuous positive airway pressure treatment was associated with reduction in preproliferative/proliferative DR. Interventional studies are needed to assess the impact of OSA treatment on STDR.

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Clinical and Polysomnographic Predictors of Short-Term Continuous Positive Airway Pressure Compliance

Cited by 74 publications

References 46 publications

User Compliance and Behavioral Adaptation Associated With Supine Avoidance Therapy

User Compliance and Behavioral Adaptation Associated With Supine Avoidance Therapy

Sleep Quality, Short-Term and Long-Term CPAP Adherence

Obstructive Sleep Apnea and Retinopathy in Patients with Type 2 Diabetes. A Longitudinal Study

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