Intensiveversusstandard follow-up to improve continuous positive airway pressure compliance

Abstract

We aimed to compare the effect of intensive versus standard interventions on continuous positive airway pressure (CPAP) adherence 2 years after CPAP initiation, as well as on sleepiness, quality of life, depression, hospitalisation and death rate due to cardiovascular disease (CVD). 3100 patients with newly diagnosed sleep apnoea were randomised into the standard group, with usual follow-up care, or the intensive group, with additional visits, telephone calls and education. Subjective daytime sleepiness (Epworth Sleepiness Scale; ESS), quality of life (36-item Short Form Health Survey; SF-36) and the patient's level of depression (Beck Depression Inventory; BDI) were recorded before and 2 years after CPAP initiation, together with CVD hospitalisations and death rate.2 years after CPAP initiation, the intensive group used CPAP significantly more than the standard group (6.9 versus 5.2 h per night; p,0.001). ESS, SF-36 and BDI scores were also significantly better in the intensive group. Furthermore, the standard group had significantly more deaths and hospitalisations due to CVD.CPAP usage can be improved by both intensive and standard patient support. However, the patients who received intensive CPAP support had significantly better ESS, BDI and SF-36 scores, and lower cardiovascular morbidity and mortality, suggesting that an intensive programme could be worthwhile. @ERSpublications Intensive CPAP support improves sleepiness, quality of life, depression, hospitalisation and death rate

Should use of 4 hours continuous positive airway pressure per night be considered acceptable compliance?

“…Cardiovascular incidence for 2 years was 1.28% and cardiovascular mortality was 0.7% for patients with severe OSA with o4 h of CPAP use. Although these data seem lower than in the study by BOULOUKAKI et al [18], in another large RCT the subgroup with better CPAP compliance (5.96 h?night -1 ) had an estimated cardiovascular incidence (without hypertension incidence) of 7.3% for 2 years [7].…”

“…Accordingly, CPAP use increased in .1 h?night -1 producing clinical improvement. In this issue of the European Respiratory Journal, BOULOUKAKI et al [18] present results from the largest RCT on this topic comparing the effect of multidimensional versus standard strategies on CPAP compliance for 2 years of follow-up. The authors randomised 3100 newly diagnosed OSA patients to the standard group or the intensive group.…”

“…In the study by BOULOUKAKI et al [18], the multidimensional intervention was an independent factor used to explain cardiovascular mortality reduction. This means that an increase of 1.7 h?night -1 resulted in a survival improvement.…”

“…Another important aspect of the study by BOULOUKAKI et al [18] was the economical evaluation, which took into account the intervention burden and the economical saving caused by the prevention of hospital admissions due to cardiovascular problems. This resulted in an incremental burden of J100 with a saving of J41 713.…”

Insomnia and excessive daytime sleepiness in obstructive sleep apnea: only different clinical phenotypes?

“…The main question is then, how can treating physicians deal with the multiple CPAP non-adherence issues that are commonly seen in such patients? The last may only be achieved in a wellorganized CPAP clinic where intense follow-up and physiologic support as well as pharmacologic approaches may be applied [20]. For example nonbenzodiazepine agents have hypnotic and sedative effects similar to those of benzodiazepines, but some may have fewer muscle-relaxant effects, thus offering a more favorable treatment approach to insomnia in OSA.…”