CPAP Adherence Predictors in a Randomized Trial of Moderate-to-Severe OSA Enriched With Women and Minorities

May, Anna; Gharibeh, Tarek; Wang, Lu; Hurley, Amanda L; Walia, Harneet K.; Strohl, Kingman P.; Mehra, Reena

doi:10.1016/j.chest.2018.04.010

Cited by 54 publications

(28 citation statements)

References 49 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…В свою очередь, коморбидность, как правило, нарастает с возрастом. В нашем исследовании, так же как и в ряде других [40][41][42][43][44][45][46][47][48][49][50], приверженные ПАП-терапии больные оказались старше по возрасту и имели более высокий ИАГ в сравнении с неприверженными. В многоцентровом исследовании J. Nogueira и соавт.…”

Section: Discussionunclassified

PAP-therapy adherence in patients with obstructive sleep apnea and cardiovascular diseases

et al. 2021

View full text Add to dashboard Cite

Materials and methods. The study included 119 patients with obstructive sleep apnea (OSA) and cardiovascular diseases (CVD) who were followed up at the National Medical Research Center of Cardiology of the Ministry of Health of the Russian Federation in the period from 2012 to 2020, and have been receiving positive airway pressure (PAP) therapy (93 men, 78.2%). The median follow-up was 3.0 years [1.5; 5.0]. The adherence criteria were the following: the usage of the PAP device for at least 71% of nights a year, and at least 4 hours per night. Results. 64.3% of patients met the criteria for adherence to PAP therapy (use more than 4 hours/night, more than 71% of nights). The adherent patients were older (64.0 years [58.5; 68.0] versus 59.0 years [53.0; 65.0] resp., p=0.03) and had a higher apnea-hypopnea index AHI (47.7 events/h [37.5; 64.4] versus 38.2 events/h [30.4; 52.7] resp., p=0.04). Patients with stage III of hypertension were using a PAP device every night significantly less (3.4 h/night [1.1; 3.6] versus 6.3 h/night [5.3; 7.4] respectively, p=0.00) in comparison with patients with hypertension stages III. The adherence of patients with or without coronary artery disease (CAD) and paroxysmal atrial fibrillation (AF) did not differ. There was no significant difference in the incidence of stage III hypertension, CAD, and permanent AF between the groups of adherent and non-adherent to PAP therapy patients. Conclusion. 63.4% of patients with CVD were adherent to PAP therapy. Adherent patients were older and had a higher AHI. Patients with stage III hypertension were worse adherent to PAP therapy in comparison with patients with hypertension of lesser stages. The CVDs course in adherent and non-adherent patients did not differ.

show abstract

Section: Discussionunclassified

PAP-therapy adherence in patients with obstructive sleep apnea and cardiovascular diseases

et al. 2021

View full text Add to dashboard Cite

show abstract

“… 14 In the USA, CPAP adherence was low in black subjects and lower socioeconomic residential areas 15 and was strongly associated with white race. 16 A Singaporean retrospective study showed that 50% of OSA patients continued CPAP therapy within five years. 17 A meta-analysis study indicated that the rate of CPAP adherence remains low over the last 20 years.…”

Section: Discussionmentioning

confidence: 99%

Acceptance and Compliance of Continuous Positive Airway Pressure in Patients with Obstructive Sleep Apnea: Local Population Survey

Abri¹,

Al-Harmeli²,

Al-Habsi³

et al. 2020

Oman Med J

View full text Add to dashboard Cite

Objectives: Continuous positive airway pressure (CPAP) compliance of > 4 hours per night has been considered acceptable to achieve clinical improvements in patients with obstructive sleep apnea (OSA). However, the factors determining CPAP adherence are unclear. This study aims to address the issue of acceptance and adherence to CPAP treatment in the Omani population and to determine the factors affecting adherence to CPAP. Methods: This retrospective study included adult OSA patients who underwent polysomnography between January 2008 and December 2014 (n = 3046). Demographic information, Epworth Sleepiness Scale (ESS), apnea/hypopnea index (AHI), and desaturation events were collected from the sleep laboratory records. Subjects were grouped as CPAP users and CPAP non-users. CPAP users were divided into compliers (> 4 hours/night) and non-compliers (< 4 hours/night). Student’s t-test was used to find differences in CPAP users and non-users, compliers, and gender differences in CPAP users. The association of CPAP compliers and non-compliers with age, gender, AHI, ESS, and comorbidities were assessed using the chi-square test. Results: Out of the 90.0% patients advised CPAP treatment, 34.7% came for regular CPAP follow-up. Total CPAP compliers were 59.3% (n = 274). The CPAP users had higher age, high ESS, baseline AHI, and more oxygen desaturation events than CPAP non-users (p < 0.010). Among the CPAP users, females were significantly older than males and had more oxygen desaturation events. CPAP compliers had significantly higher baseline AHI and more oxygen desaturation events. There was no association between CPAP compliance and age, gender, AHI, ESS, or comorbidities. Conclusions: CPAP users and compilers have severe OSA. CPAP acceptance and adherence are suboptimal and could not be predicted by age, gender, AHI, ESS, or comorbidities.

show abstract

“…The substantial impact of allocation to therapy adherence has already been reported in other interventional trials by other groups involving sham CPAP devices and seems to be a universal phenomenon across sex, race, and ageboundaries. [23,[35][36][37] In the literature, this phenomenon is also referred to as the "Hawthorne effect", where individuals modify an aspect of their behavior in response to their awareness of being observed. Interestingly, in multivariable analyses, the treatment allocation was the strongest predictor of CPAP adherence within RCTs.…”

Section: Discussionmentioning

confidence: 99%

Effects of suboptimal adherence of CPAP therapy on symptoms of obstructive sleep apnoea: a randomised, double-blind, controlled trial

et al. 2019

View full text Add to dashboard Cite

IntroductionContinuous positive airway pressure (CPAP) is currently the treatment of choice for sleepiness in patients with obstructive sleep apnoea (OSA); however, adherence is often thought to be suboptimal. We investigated the effects of suboptimal CPAP usage on objective and subjective sleepiness parameters in patients with OSA.Material and methodsIn this 2-week, parallel, double-blind, randomised controlled trial we enrolled moderate-to-severe OSA patients with excessive pre-treatment daytime sleepiness (Epworth sleepiness scale (ESS) score >10 points) who had suboptimal CPAP adherence over ≥12 months (mean nightly usage time 3–4 h). Patients were allocated through minimisation to either subtherapeutic CPAP (“sham CPAP”) or continuation of CPAP (“therapeutic CPAP”). A Bayesian analysis with historical priors calculated the posterior probability of superiority.ResultsBetween May, 2016 and November, 2018, 57 patients (aged 60±8 years, 79% male, 93% Caucasian) were allocated in total, and 52 who completed the study (50% in each arm) were included in the final analysis. The unadjusted ESS score increase was 2.4 points (95% CI 0.6–4.2, p=0.01) in the sham-CPAP group when compared to continuing therapeutic CPAP. The probability of superiority of therapeutic CPAP over sham CPAP was 90.4% for ESS, 90.1% for systolic blood pressure and 80.3% for diastolic blood pressure.ConclusionsPatients with moderate-to-severe OSA and daytime sleepiness are still getting a substantial benefit from suboptimal CPAP adherence, albeit not as much as they might get if they adhered more. Whether a similar statement can be made for even lower adherence levels remains to be established in future trials.

show abstract

CPAP Adherence Predictors in a Randomized Trial of Moderate-to-Severe OSA Enriched With Women and Minorities

Abstract: ClinicalTrials.gov; No.: NCT00607893; URL: www.clinicaltrials.gov.

Cited by 54 publications

References 49 publications

PAP-therapy adherence in patients with obstructive sleep apnea and cardiovascular diseases

PAP-therapy adherence in patients with obstructive sleep apnea and cardiovascular diseases

Acceptance and Compliance of Continuous Positive Airway Pressure in Patients with Obstructive Sleep Apnea: Local Population Survey

Effects of suboptimal adherence of CPAP therapy on symptoms of obstructive sleep apnoea: a randomised, double-blind, controlled trial

Contact Info

Product

Resources

About