Effects of a Short Course of Eszopiclone on Continuous Positive Airway Pressure Adherence

Lettieri, Christopher J.; Shah, Anita; Holley, Aaron B.; Kelly, William F.; Chang, Audrey S.; Roop, Stuart

doi:10.7326/0003-4819-151-10-200911170-00006

Cited by 123 publications

(60 citation statements)

References 33 publications

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“…This may reflect improvements in sleep initiation and reductions in insomnia, which has been shown to enhance therapeutic adherence with CPAP among non-PTSD patients. 29 While CPAP was used more often and for longer periods among PTSD patients using sedating medications, adherence was still lower than that observed in the control group, suggesting that the diminished use of CPAP among patients with PTSD is likely multifactorial.…”

Section: Discussionmentioning

confidence: 91%

“…The majority of our patients were habitually using sedating medications; prior studies have shown that non-benzodiazepine sedative-hypnotics may improve CPAP adherence. 29,50,51 This likely diminished the observed differences in CPAP use, as we found that patients using sedating agents had increased use of CPAP than patients not using sedatives. Despite this, PTSD still impaired CPAP adherence regardless of concomitant sedative use.…”

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confidence: 80%

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The Impact of Posttraumatic Stress Disorder on CPAP Adherence in Patients with Obstructive Sleep Apnea

Collen

Lettieri

Hoffman

2012

Journal of Clinical Sleep Medicine

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Introduction:Obstructive sleep apnea (OSA) is a common comorbid condition in patients with posttraumatic stress disorder (PTSD); insuffi ciently treated OSA may adversely impact outcomes. Sleep fragmentation and insomnia are common in PTSD and may impair CPAP adherence. We sought to determine the impact of combat-related PTSD on CPAP adherence in soldiers. Methods: Retrospective case-control study. Objective measures of CPAP use were compared between OSA patients with and without PTSD. Groups were matched for age, BMI, and apnea-hypopnea index (AHI). Results: We included 90 patients (45 Control, 45 PTSD). Among the cohort, mean age was 39.9 ± 11.2, mean BMI 27.9 ± 8.0, mean ESS 13.6 ± 5.7, and mean AHI 28.2 ± 22.4. There was a trend towards a higher rate of comorbid insomnia among patients with PTSD (25.8% vs. 11.1%, p = 0.10). PTSD was associated with signifi cantly less use of CPAP. Specifi cally, CPAP was used on 61.4% ± 22.2% of nights in PTSD patients compared with 76.8% ± 16.4% in patients without PTSD (p = 0.001). Mean nightly use of CPAP was 3.4 ± 1.2 h in the PTSD group compared with 4.7 ± 2.2 h among controls (p < 0.001). Regular use of CPAP (> 4 h per night for > 70% of nights) was also lower among PTSD patients (25.2% vs. 58.3%, p = 0.01). Conclusion: Among soldiers with OSA, comorbid PTSD was associated with signifi cantly decreased CPAP adherence. Given the potential for adverse clinical outcomes, resolution of poor sleep quality should be prioritized in the treatment of PTSD and potential barriers to CPAP adherence should be overcome in patients with comorbid OSA. Keywords: Posttraumatic stress order, sleep apnea, obstructive sleep apnea, CPAP, CPAP compliance, CPAP adherence, sleep disordered breathing, deployment related sleep disorders Citation: Collen JF; Lettieri CJ; Hoffman M. The impact of posttraumatic stress disorder on CPAP adherence in patients with obstructive sleep apnea.

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Section: Discussionmentioning

confidence: 91%

mentioning

confidence: 80%

The Impact of Posttraumatic Stress Disorder on CPAP Adherence in Patients with Obstructive Sleep Apnea

Collen

Lettieri

Hoffman

2012

Journal of Clinical Sleep Medicine

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“…21 A prospective use of short-term eszopiclone use improved CPAP use from 2.4 to 3.6 hours. 13 Other interventions that improved CPAP compliance were in cases where baseline or placebo group use was under 5 hours ( Table 6). Our placebo group's average compliance was already 6.5 h/night.…”

Section: Discussionmentioning

confidence: 99%

“…12 In contrast, Lettieri et al found that eszopiclone for the fi rst 14 nights of CPAP was associated with greater long-term compliance than placebo. 13 Their group, in a retrospective study, also found an association between hypnotic (mostly zolpidem, and to lesser extent eszopiclone) use during CPAP titration and improved compliance at 4-6 weeks.…”

Section: S C I E N T I F I C I N V E S T I G a T I O N Smentioning

confidence: 91%

Impact of Zaleplon on Continuous Positive Airway Pressure Therapy Compliance

Park

Olson

Morgenthaler

2013

Journal of Clinical Sleep Medicine

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“…23 Other intervention-based trials aimed at improving CPAP adherence have employed sample sizes ranging from 100 to 373 participants. [23][24][25][26][27] However, the current pilot study aimed to recruit much less than that to assess feasibility and obtain preliminary data.…”

Section: Sample Size Estimationmentioning

confidence: 99%

A Pilot Study Of CPAP Adherence Promotion By Peer Buddies With Sleep Apnea

Parthasarathy

Wendel

Haynes

et al. 2012

B108. Diagnostic and Therapeutic Approaches in Sleep Apnea

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BRIEF SUMMARYCurrent knowledge/Study Rationale: Poor adherence to the primary treatment of OSA-continuous positive airway pressure (CPAP) therapy-is common, and there is a paucity of easily accessible yet costeffective interventions that could promote CPAP adherence. Promoting adherence to therapy through peer-driven intervention is cost-effective and has met with modest success in other chronic conditions such as HIV, heart failure and diabetes mellitus, but whether such a peer-driven intervention can improve adherence to CPAP therapy is unknown. Study Impact: Our pilot study involved such a peer-driven intervention (experienced CPAP users called "peer-buddies") and suggests that such an intervention is feasible, results in high patient satisfaction, and promotes CPAP adherence. A larger, adequately powered study is needed, which, if successful, could potentially improve outcomes in a "patientcentered" and cost-effective manner.

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Effects of a Short Course of Eszopiclone on Continuous Positive Airway Pressure Adherence

Abstract: Compared with placebo, a short course of eszopiclone during the first 2 weeks of CPAP improved adherence and led to fewer patients discontinuing therapy.

Cited by 123 publications

References 33 publications

The Impact of Posttraumatic Stress Disorder on CPAP Adherence in Patients with Obstructive Sleep Apnea

The Impact of Posttraumatic Stress Disorder on CPAP Adherence in Patients with Obstructive Sleep Apnea

Impact of Zaleplon on Continuous Positive Airway Pressure Therapy Compliance

A Pilot Study Of CPAP Adherence Promotion By Peer Buddies With Sleep Apnea

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