Long-Term Compliance to Continuous Positive Airway Pressure Therapy (nCPAP) Set Up During a Split-Night Polysomnography

Fleury, Bernard; Rakotonanahary, Dominique; Tehindrazanarivelo, Alain Djacoba; Hausser‐Hauw, Chantal; Lebeau, B

doi:10.1093/sleep/17.6.512

Cited by 58 publications

(41 citation statements)

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“…The refusal percentage of the current study of 4%, however, was considerably lower than those previously reported for split-night studies (22±37.5%) [10,11]. The reason for this greater acceptance rate is uncertain, but may relate to the use of extensive education before all split-night studies, similar to that used before CPAP titration nights for full-night patients.…”

Section: Discussioncontrasting

confidence: 64%

“…The split-night technique was believed to be reliable and cost saving, but no other assessment of effectiveness was made and there were no measurements of interventions needed. FLEURY et al [10] found CPAP use among those taking the CPAP device home was 80%, after a mean follow-up time of 9.5 months. The current study also found 80% of patients using CPAP at 9.5 months and found, after a longer follow-up of 22 months, that 78% were still using CPAP.…”

Section: Discussionmentioning

confidence: 99%

“…FLEURY et al [10] evaluated 31 patients booked for split-night studies, with a mean CPAP nightly use of 6.7 h in those continuing to use CPAP (n=17). It was concluded that patients undergoing splitnight studies had similar CPAP use to those undergoing full-nights studies; however, this conclusion was based on uncontrolled historical comparisons with full-night studies.…”

Section: Discussionmentioning

confidence: 99%

“…The reason for this greater acceptance rate is uncertain, but may relate to the use of extensive education before all split-night studies, similar to that used before CPAP titration nights for full-night patients. In contrast, FLEURY et al [10] did not report the use of education prior to splitnight studies and STROLLO et al [11] reported only that patients were allowed to try a variety of commercially available masks prior to the study.…”

Section: Discussionmentioning

confidence: 99%

“…The few evaluations that have included clinically relevant outcomes have not used a control group [10], or, when a control group was used, the numbers were small (n=12, in each group) and the outcome evaluation was limited to mean nightly CPAP use at the initial clinic visit [11]. Therefore, a larger scale study of the value of split-night studies was performed.…”

mentioning

confidence: 99%

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Split-night versus full-night studies for sleep apnoea/hypopnoea syndrome

McArdle¹,

Grove²,

Devereux³

et al. 2000

Eur Respir J

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Investigation and treatment of sleep apnoea/hypopnoea syndrome (SAHS) is placing increasing demands on healthcare resources. This workload may be reduced by using split-night studies instead of the standard full-nights of diagnostic polysomnography and continuous positive airway pressure (CPAP) titration. Splitnight studies involve polysomnography in the first half of the night followed, if there is an abnormal frequency of apnoeas and hypopneas, by CPAP titration for the remainder of the night.The authors' database of all patients prescribed a CPAP trial 1991±1997 was used to compare long-term outcomes in all 49 (46 accepting CPAP) patients prescribed split-night studies with those in full-night patients, matched 1:2 using an apnoea/ hypopnoea index (AHI) of 15% and Epworth score of 3 units.Classical symptoms of SAHS were the main reason for the split-night studies (n=27). There were no differences between the groups in long-term CPAP use, median nightly CPAP use (split-night 6.0 h . night -1 , interquartile range (IQR) 3.8±7.4, fullnight; 6.2 h . night -1 , IQR 3.7±7.0, p=0.9), post-treatment Epworth scores and frequency of nursing interventions/clinic visits required. The median time from referral to treatment was less for the split-night patients (13 months, IQR 11±20 months) than for full-night patients (22 months, IQR 12±34 months; p=0.003).Split-night studies, in selected patients, result in equivalent long-term continuous positive airway pressure use to full-night studies with shorter treatment times and less healthcare utilization. Eur Respir J 2000; 15: 670±675. Sleep apnoea/hypopnoea syndrome (SAHS) is a common condition, affecting 2±4% of the middle-aged population [1]. The consequences of SAHS include daytime sleepiness, altered mood and impaired cognitive function [2,3] leading to reduced quality of life [4,5] and an increased risk of accidents at work and on the road [6±8]. Many sleep centres are struggling to cope with the number of patients being referred and the financial restrictions placed on their investigation. One way of reducing the time taken to investigate and treat patients is to use splitnight studies whereby diagnostic polysomnography and continuous positive airway pressure (CPAP) titration are accomplished on the same night rather than the standard two nights consisting of a diagnostic polysomnography night and subsequent CPAP titration night (full-night patients).Despite the potential savings, split-night studies are not widely used in all countries, at least partly because of concerns about the unknown long-term outcome of these studies [9]. The few evaluations that have included clinically relevant outcomes have not used a control group [10], or, when a control group was used, the numbers were small (n=12, in each group) and the outcome evaluation was limited to mean nightly CPAP use at the initial clinic visit [11]. Therefore, a larger scale study of the value of split-night studies was performed. MethodsUsing the authors' database of 1,211 patients booked for CPAP tit...

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Section: Discussioncontrasting

confidence: 64%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Split-night versus full-night studies for sleep apnoea/hypopnoea syndrome

McArdle¹,

Grove²,

Devereux³

et al. 2000

Eur Respir J

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Sleep and Sleep Disorders

Shochat¹,

Ancoli‐Israel²

Geriatric Medicine

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eye movement (REM) and nonrapid eye movement (NREM). NREM sleep is further subdivided into sleep stages 1 through 4, which represent a continuum from light sleep (stage 1) to deep sleep (stages 3 and 4). REM sleep is characterized by rapid eye movements similar to those seen in the waking state, as well as muscle atonia.Healthy human individuals show stable and distinct patterns of sleep architecture, that is, the cyclic alternations of the different sleep stages. Sleep is entered through the transitional stage 1, and followed by stages 2, 3, and 4, respectively. After about 90 min, through stage 2 sleep, REM sleep begins. The first appearance of REM sleep during the night is termed REM latency. This 90-to 100-min cycle repeats itself typically four to five times during the night. However, the internal temporal structure changes, so that at the beginning of the night stages 3 and 4 are long while REM sleep is short, and as the night progresses, the amount of stages 3 and 4 decreases, while the amount of REM sleep increases.Both REM sleep and non-REM sleep stages 3 and 4 are homeostatically driven; that is, selective deprivation of each of these states subsequently causes a rebound in their appearance once the person is allowed to sleep. This finding leads to the ubiquitous assumption that both are essential in the sleep process and its many functions. 3 REM sleep may also be driven by a circadian oscillator, as studies have shown that REM is temporally coupled with the circadian rhythm of temperature. 4Because the prevalence of several medical and psychiatric conditions that affect sleep, as well as the prevalence of specific sleep disorders, is high in the elderly population, it is extremely difficult to portray the picture of the "normal" elderly sleeper. Nevertheless, studies of agerelated changes in sleep architecture have found some common characteristics. Sleep efficiency, defined as the The prevalence of sleep complaints increases dramatically with age and is estimated to be about 40% in the elderly population. 1 These complaints include difficulty falling asleep, waking up at night, waking up too early in the morning, not feeling well rested, and needing to nap during the day. In an epidemiologic study of more than 9000 participants aged 65 and over, more than half reported at least one sleep complaint occurring most of the time. 2 Women were more likely to report nighttime complaints but were less likely to nap during the day compared to men. The most common complaint was waking up at night (30%), followed by daytime naps (25%) and difficulty falling asleep (19%). Less than 20% reported rarely or never having any sleep complaint. Sleep complaints were associated with coexisting health disorders, including poor self-perceived health, depressive symptoms, respiratory symptoms, physical disabilities, chronic medical conditions, and medication use. However, of the healthy minority in this study, over one-fourth reported at least one chronic sleep complaint.Although age-related changes do occur in normal slee...

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Respiratory Disorders

Engman¹,

Richie²

2000

Medical Selection of Life Risks

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Long-Term Compliance to Continuous Positive Airway Pressure Therapy (nCPAP) Set Up During a Split-Night Polysomnography

Cited by 58 publications

References 0 publications

Split-night versus full-night studies for sleep apnoea/hypopnoea syndrome

Split-night versus full-night studies for sleep apnoea/hypopnoea syndrome

Sleep and Sleep Disorders

Respiratory Disorders

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