Long-term adherence to CPAP treatment in patients with obstructive sleep apnea: importance of educational program

Abstract

BackgroundLack of adherence with continuous positive airway pressure (CPAP) therapy is the major cause of treatment failure in patients with obstructive sleep apnea syndrome. We evaluated the effectiveness of our intensive educational program on adherence in the short term and the long term.MethodsThe educational program consisted of: intensive training, whereby each patient performed individual and collective sessions of three hours receiving information about obstructive sleep apnea syndrome, familiarizing themselves with CPAP tools, on six consecutive days; long-term training; and support meetings, with reassessment at three months and one year.ResultsIn 202 patients with obstructive sleep apnea syndrome, the mean (standard deviation) apnea/hypopnea index was 45 ± 22, the Epworth Sleepiness Scale score was 14 ± 5, and the average titration pressure was 10 ± 2 cm H2O. At three months, 166 patients (82%) used CPAP for an average of 7.3 hours per night. At one year, 162 (80%) used CPAP for about seven hours per night. At two years, 92 patients (43%) used CPAP for about five hours per night. The level of satisfaction remained higher in patients in ventilation.ConclusionOur data show strong adherence to CPAP at three months and one year, with a decrease at two years. The initial educational program seems to play an important role in adherence. This effect is lost in the long term, suggesting that periodic reinforcement of educational support would be helpful.

Improved prediction of CPAP failure using T90, age and gender

“…We assumed that age would influence the success rate of CPAP treatment since impairment in cognitive abilities associated with older age would be expected to impact compliance (Šedová et al, 2016). Good communication plays a particularly critical role in elderly patients (La Piana et al, 2011;Morales et al, 2012). Our supposition was confirmed; however, the predictive ability of age was found too weak for clinical praxis.…”

5-Years APAP adherence in OSA patients – Do first impressions matter?

“…It has been stressed in the literature [44,45] that education plays an important role in adherencedinformed patients tend to be motivated patients. The use of educational sessions for patients seems to have good results [34] although the durability of different strategies to enhance adherence is still under debate [12]. In a previous study referring to the impact of a group education session on APAP compared to patients who had not had it, we found increased adherence to APAP at 6 months [36].…”

“…Since treatment adherence is widely recognized as a critical problem in the OSA treatment in short and even more so in the long term [12], it is important to determine factors that could help predict treatment compliance since it would enable the creation of mechanisms aiming at improving the long term effectiveness of such treatment. Although various attempts have been made to predict and identify factors which predict short and long term compliance, the available data is diverse and conflicting [13e16].…”

Risk factors for failure of continuous positive airway pressure treatment in patients with ostructive sleep apnoea

“…The essential difference between CPAP and BiPAP is that while the former is set to a single pressure level, the BiPAP has two pressure settings: the prescribed pressure for inhalation and a lower pressure for exhalation. Patients are given proper a priori instructions on the use of the positive airway pressure device 14,15 . However, the CPAP treatment is still ineffective in about 13% of cases.…”