Chest
Volume 111, Issue 5, May 1997, Pages 1273-1277
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Clinical Investigations: Sleep and Breathing
Group Education Sessions and Compliance With Nasal CPAP Therapy

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Study objectives

To determine an effective means of improving compliance with nasal continuous positive airway pressure (CPAP) for obstructive sleep apnea (OSA).

Design

Retrospective chart review.

Setting

An outpatient clinic at a Veterans Affairs Medical Center.

Patients

Seventy-three patients with OSA.

Interventions

Hour meters on CPAP machines provided documentation of nightly machine use. A 2-h group CPAP clinic, scheduled every 6 months, provided education, support, symptom treatment, and equipment monitoring for all CPAP patients.

Results

Twenty-five patients had hour meter readings taken at their first CPAP clinic. In these patients, nightly CPAP use increased from 5.2±0.6 to 6.3±0.6 h per night after attendance at one CPAP clinic (p<0.05). CPAP use increased from 5.2±0.5 before CPAP clinic to 6.3±0.6 h per night after attendance at all subsequent CPAP clinics for 34 patients (p<0.05), an improvement that was sustained over 605±34 days. Twenty-nine percent of patients increased nightly CPAP use by at least 2 h, while only 6% decreased by ≥2 h (p<0.025). Patients receiving supplemental oxygen had higher CPAP use prior to CPAP clinic compared to patients not receiving oxygen (p<0.05).

Conclusions

Attendance in a group clinic designed to encourage patient compliance with CPAP therapy provided a simple and effective means of improving treatment of OSA.

Section snippets

MATERIALS AND METHODS

Seventy-three patients were identified as using CPAP via nasal mask or pillows in April 1994 at the Veterans Affairs Medical Center in Providence, RI. All patients had been diagnosed as having OSA, either by attended afternoon nap polysomnography study or by portable polysomnography (Edentec; Eden Prairie, Minn) overnight study. Nap studies monitored heart rate, oxygen saturation, two-lead EEG, genioglossus electromyogram, extraocular eye movements, chest wall excursion by impedance, and nasal

RESULTS

Thirty-four patients attended CPAP clinic and had sufficient meter readings to calculate hours per night of CPAP use before and after their first clinic visit. The characteristics of these patients are listed in Table 1. All patients were male and of a wide range of ages. Mean AHI was 34 prior to treatment. The total time reviewed for the duration of the study averaged >3 years. Mean number of CPAP clinics attended was four.

Figure 1 shows the hours per night of CPAP machine operation. The mean

DISCUSSION

In this retrospective chart review, we assessed CPAP nightly use by patients who attended a CPAP clinic designed to educate and encourage patient compliance with prescribed CPAP therapy. The results demonstrated that nightly CPAP use improved and that this improvement was sustained over years in patients who attended at least one CPAP clinic. Significantly more patients had a >2 h increase in nightly CPAP use than had a nightly decrease of at least 2 h. Patients receiving supplemental oxygen

ACKNOWLEDGMENTS

The authors thank Richard Millman, MD, for helpful discussions and William Silvia, RN, and Jayne Matoian, RRT, Vanguard Home Medical Care, for excellent assistance with patient education.

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Partially supported by a Department of Veterans Affairs Merit Review Grant, by NHLBI Grant HL34009, and by Glaxo-Wellcome, Inc.

Some data presented at the American Thoracic Society annual meeting, May 1995, and published in abstract form in the American Journal of Respiratory and Critical Care Medicine (1995; 151:A681).

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