Long‐Term Compliance with Continuous Positive Airway Pressure in Patients with Obstructive Sleep Apnea

Abstract

BACKGROUND: Continuous positive airway pressure (CPAP) is an effective treatment for obstructive sleep apnea (OSA). However, compliance is a significant problem and has been incompletely assessed in long-term studies.OBJECTIVE: To assess the long-term compliance of OSA patients with CPAP therapy.SUBJECTS: Eighty patients who had had a diagnosis of OSA at least four years previously and received a written prescription for CPAP were evaluated.METHODS: Subjects were identified by reviewing sleep laboratory records. Participants were contacted by telephone and were asked to quantitate their CPAP use (hours per night, nights per week) and to evaluate whether there had been improvement in symptoms. Those who commenced but subsequently abandoned therapy and those who never initiated treatment were questioned about their reasons for noncompliance.RESULTS: Patient demographics included mean (± SD) age (58±11 years), male sex (70 of 80 patients [88%]) and mean apnea-hypopnea index (70±44 events/h). At the time of the interview (64.0±3.7 months after diagnosis), 43 of 80 patients (54%) were still using CPAP and most reported an improvement in symptoms. Twelve of 80 patients (15%) had abandoned CPAP after using it for 10.1±15.5 months, and 25 of 80 patients (31%) had never commenced therapy after initial diagnosis and CPAP titration. Analysis of scores reflecting initial patient sleepiness revealed a significant association of this symptom with subsequent CPAP compliance.CONCLUSION: Although many patients with OSA derive subjective benefit from, and adhere to treatment with CPAP, a significant proportion of those so diagnosed either do not initiate or eventually abandon therapy. Initial experience with CPAP appears to be important, reinforcing the need for early education and support in these patients.

Effect of Heated Humidification on CPAP Therapy Adherence in Subjects With Obstructive Sleep Apnea With Nasopharyngeal Symptoms

“…Our study selected a group of subjects with OSA who experienced problems with nasal-oral adverse effects during the first night of a CPAP trial. Prior studies have shown that the most common reason for not initiating CPAP is general displeasure or discomfort with the CPAP device during the CPAP titration trial 17 or during the first night of therapy. 2 We aimed to improve the symptoms related to CPAP early in this group rather than waiting for nasopharyngeal symptoms to occur later after the use of CPAP.…”

Assessment of Obstructive Sleep Apnea in Adults Undergoing Bariatric Surgery in the Longitudinal Assessment of Bariatric Surgery-2 (LABS-2) Study

“…9 Self-reported PAP compliance (i.e., use among those with OSA), which was similar between participants with and without past-year AHI (83.0% and 81.2%, respectively), was higher than objectively determined compliance reported in the general population, which is between 40% and 60% one year after starting PAP. 34,35 Differences in assessment method may explain this discrepancy since patient self-report of PAP compliance is generally higher than compliance based on electronic data downloaded from PAP machines. 36 However, it is also possible that this population is more compliant in general, or was more compliant than usual in the immediate period leading up to surgery.…”

Leak Profile Inspection During Nasal Continuous Positive Airway Pressure

“…5 Adverse effects are common, [6][7][8][9][10] and overall adherence to CPAP therapy is poor, because patients often abandon therapy within the first month. [11][12][13][14] The monitoring of CPAP therapy is now possible with the advent of CPAP machines that gather statistical and graphical information on use and efficacy. Current CPAP machines collect data on time-at-pressure, apneas, hypopneas, snoring, and leaks, and those data are important in clinical follow-up, especially if the patient initiated on auto-titrating CPAP, without polysomnographic titration.…”