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

Abstract

@ERSpublications CPAP use can determine the cardiovascular risk reduction; physicians must endeavour to get the best CPAP use http://ow.ly/zPZbP Continuous positive airway pressure (CPAP) reduces blood pressure in obstructive sleep apnoea (OSA) patients, as well as in patients with resistant hypertension. The effect of CPAP is directly related to treatment compliance [1][2][3]. Observational studies have shown a reduction in cardiovascular mortality risk in severe OSA patients treated with CPAP and adequate compliance [4][5][6]. A recent randomised controlled trial (RCT) showed a reduction in cardiovascular events (including hypertension incidence) in patients with adequate CPAP compliance [7]. However, what is an adequate definition of CPAP compliance?Ideally, CPAP compliance should take place for as long as the patient is sleeping but, in practice, this occurs in a minority of subjects. Based on several studies, compliance of o4 h per night has been considered acceptable. However, dose-response studies have found that different compliance levels achieve different dimensions of clinical improvement [8][9][10][11] 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. Night-time CPAP use improved on average by .1.7 h with the multidimensional intervention than with the standard one. This resulted in an important clinical improvement but the most significant data showed that cardiovascular event incidence decreased by 50%. Hospitalisations due to new cardiovascular events occurred in 45 (2.9%) patients in the multidimensional strategy and in 96 (6.2%) in the standard strategy. From these, fatal events occurred

Using domiciliary non-invasive ventilator data downloads to inform clinical decision-making to optimise ventilation delivery and patient compliance

“…Suggesting that downloading ventilator data to assist in modifying NIV prescriptions is a useful adjunct to improve patient comfort and achieve a clinically meaningful increase in NIV compliance. Data from Masa et al 23 and Borel et al 24 suggest greater gains the longer NIV is used; thus a 2-hour increase in NIV use could result in greater patient benefit. Furthermore, the small sample size and heterogeneity of the population in this study may have resulted in a statistical underestimation of the changes observed in NIV compliance.…”

Wenn CPAP nicht genutzt oder nicht vertragen wird – Vorschlag für eine standardisierte Terminologie

“…Von einer PAP-Intoleranz sprechen wir demnach, wenn die Therapie bei initial bestehender Motivation eingeleitet wurde, jedoch aus den oben genannten Gründen ungenügend genutzt wird. Entscheidendes quantitatives Kriterium für eine PAP-Intoleranz ist eine durchschnittliche Nutzung von weniger als 4 h pro Nacht über einen längeren Zeitraum [6,8]. Die Nutzung/Nichtnutzung sollte durch einen objektiven Nachweis (z.…”

Effects of suboptimal adherence of CPAP therapy on symptoms of obstructive sleep apnoea: a randomised, double-blind, controlled trial

“…A commonly held view is that a patient should use their CPAP device for at least 4 hours per night to experience an improvement of sleepiness and daily functioning. [13][14][15][16][17][18] However, a considerable proportion of CPAP users fail to achieve this threshold. Accordingly, 46-83% of the patients on CPAP could be described as insufficiently treated, if optimal adherence were defined as >4 hours of nightly use.…”