Clin Exp Otorhinolaryngol.  2009 Jun;2(2):90-96. 10.3342/ceo.2009.2.2.90.

Compliance with Positive Airway Pressure Treatment for Obstructive Sleep Apnea

• Kim JH
• Kwon MS
• Song HM
• Lee BJ
• Jang YJ
• Chung YS

• KMID: 2007191
• DOI: http://doi.org/10.3342/ceo.2009.2.2.90

Abstract

OBJECTIVES
Positive airway pressure (PAP) is considered a standard treatment for moderate-to-severe obstructive sleep apnea (OSA) patients. However, compliance with PAP treatment is suboptimal because of several types of discomfort experienced by patients. This study investigated compliance with PAP therapy, and affecting factors for such compliance, in OSA patients.
METHODS
We performed a survey on 69 patients who engaged in PAP therapy between December 2006 and November 2007. After diagnostic polysomnography and manual titration, patients trialed PAP using the ResMed instrument and explored autoadjusting PAP (APAP), continuous PAP (CPAP), and flexible PAP (using expiratory pressure relief [EPR]) at least once every week for 1 month. Compliance measures were mean daily use (hr), percentage of days on which PAP was used, and percentage of days on which PAP was used for >4 hr. Data were obtained at night using the software Autoscan version 5.7(R) of the ResMed Inc. We obtained data on anthropometric (age, BMI, neck circumflex, Epworth sleepiness scale, Pittsburgh Sleep Quality Index, hypertension, alcohol intake), polysomnographic data (severity of apnea-hypopnea index [AHI], proportion of nonsupine sleep time, position dependence of sleep), PAP mode and AHI during PAP use for affecting factors.
RESULTS
After 1 month, 41 of the 69 patients (59.4%) were pleased with PAP therapy and purchased instruments. Twenty-four patients (34.7%) used PAP for more than 3 months. The percentage of days on which PAP was used was statistically higher in patients with hypertension than in normotensive patients (P=0.003). There were negative correlations 1) between nonsupine position sleep time and percentage of days on which PAP was used (r=-0.424, P=0.039), and 2) between the AHI during PAP use and the percentage of days on which PAP was used for >4 hr (r=-0.443, P=0.030). There were no statistical differences between AHI, BMI, PAP pressure, or other measured parameters, on the one hand, and compliance, on the other.
CONCLUSION
The affecting factors for PAP use were hypertension history, sleep posture (shorter nonsupine sleep time), and lower AHI during PAP use.

Keyword

Obstructive sleep apnea; Continuous positive airway pressure; Compliance; Hypertension; Posture

MeSH Terms

Compliance
Continuous Positive Airway Pressure
Hand
Humans
Hypertension
Neck
Polysomnography
Posture
Sleep Apnea, Obstructive

Figure

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  Fig. 1 Summary of the study protocol.*Clinical assessment baseline characteristics (age, sex, body mass index, neck circumflex, Friedman stage, hypertension status, alcohol use, smoking, sleep study data, optimal pressure in treatment study, Epworth Sleepiness Score, Pitt- sburgh Sleep Quality Index).APAP: autoadjusting positive airway pressure; CPAP: continuous positive airway pressure; EPR: expiratory pressure relief (flexible CPAP).

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  Fig. 2 Compliance of patients.APAP: autoadjusting positive airway pressure; CPAP: continuous positive airway pressure; EPR: expiratory pressure relief (flexible CPAP).

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  Fig. 3 Difference between manual titration pressure and auto-titration pressure according to PAP mode.APAP: autoadjusting positive airway pressure; CPAP: continuous positive airway pressure; EPR: expiratory pressure relief (flexible CPAP).

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