CPAP Adherence in Patients with Newly Diagnosed Obstructive Sleep Apnea prior to Elective Surgery

Abstract

Background: Obstructive sleep apnea (OSA) is prevalent in the surgical population, and it has been suggested that preoperative patients should be screened and treated for OSA. However, it remains unclear whether patients diagnosed with OSA in the preoperative period adhere to prescribed CPAP therapy. Objective: Our aim was to objectively quantify CPAP adherence, investigate predictors of poor CPAP adherence, and to establish an optimal CPAP setting in a cohort of presurgical patients diagnosed with OSA as part of the preoperative work-up. Methods: In a retrospective observational study, we collected data on all adult presurgical patients seen by the Anesthesia Perioperative Medicine Clinic (APMC) who screened positive for OSA on the STOP-Bang questionnaire and underwent an in-laboratory diagnostic polysomnogram (PSG) before surgery. CPAP was offered to patients with moderate or severe OSA. Objective CPAP adherence was recorded during the perioperative period. Factors associated with reduced CPAP adherence were delineated. Patient characteristics were compared between those with STOP-Bang scores of 3-4 and those with higher scores (STOP-Bang score ≥ 5). Results: During a 2-year period, 431 patients were referred and 211 patients completed a PSG. CPAP therapy was required in 65% of patients, and the optimal level was 9 ± 2 cm H 2 O. Objective CPAP adherence was available in 75% of patients who received CPAP therapy; median adherence was 2.5 h per night, without any signifi cant difference between the STOP-Bang subgroups. African American race, male gender, and depressive symptomatology were independent predictors of reduced CPAP adherence. Severe OSA was signifi cantly more prevalent in patients with a STOP-Bang score ≥ 5 than those whose score was 3-4 (55.1% versus 34.4%, p = 0.005). However, optimum CPAP pressure levels and adherence to therapy did not differ between the 2 STOP-Bang groups. Conclusions: Adherence to prescribed CPAP therapy during the perioperative period was extremely low. African American race, male gender, and depressive symptoms were independently associated with reduced CPAP usage. Further research is needed to identify and overcome barriers to CPAP acceptance and adherence in the perioperative setting. S C I E N T I F I C I N V E S T I G A T I O N SS ince its initial description more than 40 years ago, OSA has been gaining more interest among anesthesiologists, and there is accumulating evidence that moderate to severe OSA can increase perioperative complications.1-3 Given the important implications of untreated OSA, 4-9 the American Society of Anesthesiologists (ASA) recommends screening presurgical patients for OSA and implementing treatment if signifi cant OSA is present. 10 There is lack of consensus on the most appropriate method of screening, diagnosis, and timing of therapy implementation.11 Although most studies have focused on screening and diagnosis of OSA, less is known about CPAP therapy and adherence during the perioperative period.In this study we aimed to objectively quantif...

Adherence to Positive Airway Pressure Therapy in Hospitalized Patients with Decompensated Heart Failure and Sleep-Disordered Breathing

“…In contrast, a previous study evaluating CPAP adherence among patients with obstructive sleep apnea with a new diagnosis prior to elective surgery found poor CPAP adherence, especially among Blacks. 14 We suspect that our favorable long-term adherence rates in hospital-diagnosed patients with CHF may be dependent on early education, acclimatization, and a positive effect of PAP on their underlying condition in the hospital. Our study is also consistent with prior data showing lower adherence in Black patients.…”

Perioperative Management of Obstructive Sleep Apnea

“…Recognizing that the adherence to prescribed CPAP therapy during the perioperative period can be extremely low [41], a regular reminder on how patients identified preoperatively to have OSA and treated with CPAP have long-term health benefits in terms of improved snoring, sleep quality, daytime sleepiness, and reduction of medications for comorbidities may be needed [42].…”

Is Prediction of CPAP Adherence in Obstructive Sleep Apnea in the Perioperative Setting Feasible?

“…1 Guralnick et al describe CPAP adherence in patients with newly diagnosed OSA prior to elective surgery. 2 The major fi ndings were that African American race, male gender and depressive symptoms were associated with reduced CPAP adherence. However, we consider that some aspects of this study need clarification in order to extrapolate the fi ndings into clinical practice.…”

“…4 Secondly, the fi nding of male gender being a risk factor for poor CPAP adherence warrants further consideration. 2 We suggest that male gender may be a surrogate for risk factors or comorbidities such as smoking, obesity, or anthropometric parameters such as neck circumference.Thirdly, depressive symptomatology has been reported to be an independent predictor of reduced CPAP adherence. 5 This aspect may have a dual interpretation in the population tested in this study and is not clearly in the same direction of previous studies.…”

“…4 Secondly, the fi nding of male gender being a risk factor for poor CPAP adherence warrants further consideration. 2 We suggest that male gender may be a surrogate for risk factors or comorbidities such as smoking, obesity, or anthropometric parameters such as neck circumference.…”