Chest
Volume 97, Issue 1, January 1990, Pages 33-38
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Clinical Investigations
Long-term Compliance with Nasal Continuous Positive Airway Pressure Therapy of Obstructive Sleep Apnea

https://doi.org/10.1378/chest.97.1.33Get rights and content

In an attempt to identify predictors of long-term compliance with nasal continuous positive airway pressure (CPAP), we reviewed the records of 125 patients with obstructive sleep apnea (OSA) referred to our center for nasal CPAP trials. Severity of sleep apnea, sleep staging, daytime hypersomnolence, effectiveness of nasal CPAP, previous palatal surgery, and adverse reactions were compared in compliant and noncompliant patients. Nineteen patients did not tolerate a nasal CPAP trial in the laboratory or refused home nasal CPAP therapy. Ten patients were unavailable for follow-up. Of the remaining 96 patients, 23 (24 percent) had discontinued therapy, while 73 (76 percent) were still using nasal CPAP at 14.5 ± 10.7 months (mean ± SD). There were no statistically significant differences between the compliant and noncompliant patients in baseline apnea plus hypopnea index (AHI), baseline sleep staging, AHI while receiving nasal CPAP, sleep staging while receiving nasal CPAP, or frequency of adverse reactions during therapy. Severe daytime sleepiness was present in 65 of the 73 compliant patients and in 12 of the 23 noncompliant patients (p<0.05). Ten of 43 in the compliant group had previous palatal surgery compared with ten of 23 noncompliant patients (p<0.05). Our data confirm earlier observations in smaller samples that compliant and noncompliant patients have equally severe sleep apnea and good initial responses to nasal CPAP. Long-term compliance with nasal CPAP may be associated with the severity of daytime hypersomnolence on presentation. Previous palatal surgery was more frequent in patients who did not tolerate long-term nasal CPAP therapy.

(Chest 1990; 97:33-38)

Section snippets

METHODS

Records from all patients with OSA referred to the Georgetown University Medical Center Sleep Disorders Center, Washington, DC, for nasal CPAP trials from October 1984 to September 1987 were included in this review (n = 125). Nineteen patients refused a home nasal CPAP trial or did not tolerate nasal CPAP in the laboratory and were excluded from this review of long-term compliance. Ten patients were unavailable for follow-up. The remaining 96 patients were followed up by telephone questionnaire

RESULTS

The baseline characteristics of the 96 long-term home nasal CPAP patients are displayed in Table 1. Eighty percent complained of severe daytime sleepiness and 20 (21 percent) had undergone previous uvulopalatopharyngoplasty (UPPP) that was unsuccessful. The patients were predominantly male and obese (114.7 ± 30 kg, mean ± SD). All patients had significant OSA with sleep disruption and nocturnal hypoxemia. Table 2 shows the AHI, sleep staging, and minimum SaO2 in the entire group at baseline and

DISCUSSION

Obstructive sleep apnea can be successfully treated in most patients with nasal CPAP Sanders4 reported a dramatic reduction in sleep-disordered breathing, as measured by the apnea index in 18 of 21 patients with OSA using nasal CPAP. In our experience, 110 of our 125 patients with OSA tolerated a nasal CPAP trial and achieved remarkable alleviation of their sleep-disordered breathing. Although the utility of this therapy in OSA has been convincing, concern exists as to the realistic expectation

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Manuscript received February 17; revision accepted June 22.

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