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

Abstract

positive airway pressure (CPAP) in the perioperative setting with untreated obstructive sleep apnea (OSA). 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.First, we believe that the overall results could be separated according to the OSA severity categories of moderate or severe. This separation into two different groups could clarify the overall message of the study, since the literature suggests that more severe OSA is associated with greater CPAP adherence compared to milder severities. 3 Moreover, previous studies have shown that a higher baseline apnea-hypopnea index (AHI) was the only signifi cant independent predictor of better CPAP compliance. 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.Fourth, there is lack information about some relevant practical aspects that was not examined: (a) type of surgery and extent of postoperative pain; (b) the auto-set CPAP settings were atypical, with a pressure range of only 5 around the optimal pressure derived from polysomnography (PSG); (c) they do not report on the effi cacy of CPAP from the machine download; (d) 50% of patient who scored highly on the ques-

CPAP Adherence during the Perioperative Period

“…Esquinas and Cistulli for their thoughtful comments and careful review of our recent study in the Journal of Clinical Sleep Medicine. 1 We believe the most important fi nding of our study was that the majority of patients referred from the Anesthesia Perioperative Medicine Clinic and subsequently diagnosed with obstructive sleep apnea (OSA) were poorly adherent to auto-PAP therapy during the perioperative period (median adherence of 2.5 h per night). As we pointed out in our discussion, the overall adherence was signifi cantly lower than what we have reported in our clinical practice as well as what has been widely reported in the literature.…”