Sleep Quality, Short-Term and Long-Term CPAP Adherence

Abstract

S C I E N T I F I C I N V E S T I G A T I O N SU ntreated obstructive sleep apnea/hypopnea syndrome (OSAHS) signifi cantly affects quality of life and cardiovascular/cerebrovascular morbidities and mortality.1-4 CPAP therapy has been shown to be effective in treating sleep disordered breathing (SDB) by reducing the apnea/hypopnea index (AHI) 5 and by reducing excessive daytime somnolence (EDS). 6Despite this, CPAP acceptance and adherence are disappointingly low. A signifi cant number of patients (ranging from 30% to 80% in various studies) demonstrate an average CPAP usage of less than 4 hours per night. 7,8 Several reviews have emphasized the need to identify patients who are at the greatest risk for non-adherence, with the goal of developing techniques to maximize overall adherence. 9,10Studies have suggested that CPAP adherence can be correlated to characteristics of patients at baseline, such as the severity of OSAHS, 11-13 the level of EDS, 14 and anatomical factors (smaller nasal cross-sectional area, reduced nasal volume, and high nasal resistance 15,16 ), but the strength of these correlations has been weak. Drake et al. showed that patients whose sleep effi ciency on the CPAP titration night improved most had the greatest CPAP compliance at 47 days.17 More recently, studies using social cognitive theory 18-20 and health BRIEF SUMMARYCurrent knowledge/Study Rationale: Despite its efficacy, adherence to CPAP therapy is highly variable amongst patients with obstructive sleep apnea with large numbers of patients demonstrating inadequate adherence to CPAP. The present study is aimed at identifying early predictors of CPAP adherence from variables obtained at the time of diagnosis and titration of CPAP, thereby providing potential for early intervention. Study Impact: Our data show that better sleep quality (greater % REM) was seen in patients with higher CPAP adherence and confi rm that long term adherence was largely predicted by short term adherence. This suggests that interventions that improve sleep during or prior to the CPAP titration study may be useful in improving CPAP adherence.

Obstructive Sleep Apnea and Fatigue in Head and Neck Cancer Patients

“…48,49 The same has been reported in HNCa patients. In the study by Friedman et al, 27 all patients who had an abnormal polysomnogram were referred for CPAP titration studies with recommendation for home therapy, of which half discontinued use soon after initiation.…”

Bradyarrhythmias in the Obstructive Sleep Apnea Syndrome: Treatment Tactics

“…Данные о риске развития осложнений лечения ско-рее говорят в пользу СРАР-терапии, при которой не-желательные явления (сухость во рту, аллергические кожные реакции, вазомоторные реакции, заложен-ность носа, носовые кровотечения и другие) регистри-руются примерно в 13 % случаев [43], в то время как встречаемость ранних и поздних послеоперационных осложнений ПЭКС (включая диспозицию электрода, перфорацию миокарда, кровотечения, пневмоторакс, инфекционные осложнения, дисфункцию и дислока-цию электродов и другие) составляет до 10-35 % [30, 44,45,46]. Однако нельзя не учитывать тот факт, что основными проблемами (до 30-50 %) при проведении неинвазивной вентиляции легких являются частая непереносимость и низкая приверженность к терапии (отказ от терапии, использование приборов менее 4 часов за ночь, на протяжении менее 70 % ночей), что становится основным препятствием к долгосрочному лечению [43,47].…”

“…Однако нельзя не учитывать тот факт, что основными проблемами (до 30-50 %) при проведении неинвазивной вентиляции легких являются частая непереносимость и низкая приверженность к терапии (отказ от терапии, использование приборов менее 4 часов за ночь, на протяжении менее 70 % ночей), что становится основным препятствием к долгосрочному лечению [43,47].…”

Positive Pressure Therapy for OSA

“…They suggest possibly awakening the patient to change to the supine position. The quality of sleep on the titration night is important; in a recent study better sleep quality on the titration night improved both short term (14 days) and long-term adherence [ 5 ]. Use of the hypnotic eszopiclone during in lab titration in one study not only improved the titration but led to significantly better short-term CPAP compliance [ 6 ].…”