CPAP adherence of patients with obstructive sleep apnea

• Published in: Respiratory care 2013-09, Vol.58 (9), p.1467-1473
• Main Authors: Salepci, Banu, Caglayan, Benan, Kiral, Nesrin, Parmaksiz, Elif Torun, Comert, Sevda Sener, Sarac, Gulsen, Fidan, Ali, Gungor, Gulten Aktin
• Format: Article
• Language: English
• Subjects: Age Factors; Cardiovascular diseases; Care and treatment; Continuous Positive Airway Pressure; Demographic aspects; Female; Follow-Up Studies; Health aspects; Humans; Male; Middle Aged; Patient Compliance; Patient outcomes; Prospective Studies; Risk factors; Sleep apnea syndromes; Sleep Apnea, Obstructive - therapy; Sleep Initiation and Maintenance Disorders - etiology; Statistics
• ISSN: 0020-1324; 1943-3654
• DOI: 10.4187/respcare.02139

Continuous positive airway pressure (CPAP) and bi-level positive airway pressure (BPAP) are the gold standard treatments for obstructive sleep apnea syndrome (OSAS), but CPAP/BPAP is not well tolerated and requires long-term follow-up. We prospectively assessed subjective and objective adherence and factors that affect adherence in OSAS patients. Subjects using CPAP/BPAP were questioned about adverse effects of CPAP/BPAP and were assessed with the Epworth Sleepiness Scale (ESS) at the first, third, sixth, and twelfth month, and once every 6 months after the first year. CPAP/BPAP use and objective and subjective adherence were assessed. Subjects who used CPAP/BPAP for at least 4 hours per night for at least 70% of the days monitored were regarded as adherent, and those who did not were considered non-adherent. The relationships between adherence and demographic data, polysomnography findings, ESS scores, and adverse effects were statistically analyzed. Six-hundred forty-eight subjects who were diagnosed with OSAS by polysomnography and accepted to use CPAP/BPAP in our sleep center between January 2005 and June 2011 were included. Four-hundred fifty-one subjects (69.6%) were men, and 197 (30.4%) were women. Two-hundred forty-eight (38.3%) subjects attended follow-ups, 246 (37.9%) were called by telephone, and 154 (23.8%) could not be reached. Of the whole population, 63.9% had obtained their CPAP/BPAP machine. In the 248 subjects who attended follow-ups, subjective adherence was 85.1% and objective adherence was 64.5%. Improvement in ESS score (P < .001) and satisfactory sleep (P < .001) were found to be significantly higher in the adherent group. Chest discomfort, difficulty falling asleep, and sleep disturbances were significantly higher in the non-adherent group (all P < .01). Of the whole population, just 38.3% attended follow-ups. The objective adherence was lower than the subjective adherence in subjects who attended follow-ups. Younger subjects were more adherent, and the most important factors that correlated with adherence were substantial improvement of daytime sleepiness and effect of CPAP/BPAP on satisfactory sleep. CPAP/BPAP adherence should be followed with objective monitoring.