Long-term Compliance with Nasal Continuous Positive Airway Pressure Therapy: DISCUSSION

Obstructive sleep apnea can be successfully treated in most patients with nasal CPAP Sanders 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 for long-term compli­ance.

The nasal CPAP apparatus is bulky, cosmetically unappealing, and associated with a number of adverse reactions. The therapy must be acceptable not only to the patient but also frequently to a bedroom partner as well. Sanders analyzed long-term compliance in 24 patients with OSA being treated with home nasal CPAP. He reported a compliance rate of 75 percent. No differences in estimated daytime sleepiness, sleep apnea index, or response to nasal CPAP were detected between the compliant and noncompliant groups. This high compliance rate was attributed to patient selec­tion and to an extensive education program. The patients in our study received comparatively limited instruction on the night of the nasal CPAP trial and with institution of home therapy.
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This retrospective analysis reviews our experience with a larger number of patients with OSA over a three-year period. The following questions were ad­dressed: (1) What is the rate of long-term compliance with home nasal CPAP? (2) Do compliant and noncom­pliant patients differ in their responses to nasal CPAP? (3) Are there characteristics that distinguish the com­pliant from noncompliant?

Our findings are consistent with previous reports that indicate an acceptable long-term compliance rate. Seventy-three (76 percent) of 96 home CPAP patients were compliant at the time of follow-up. The over­whelming majority of compliant patients used nasal CPAP therapy nightly (96 percent) with only three patients reporting weekend omission of CPAP or alternate night use. However, if all patients with OSA prescribed a nasal CPAP trial are considered (n = 115), only 63 percent were able to effectively use home nasal CPAP on a long-term basis. Baker and co­workers reported similar results with OSA patients and home nasal CPAP In their study, 68 of the 103 patients referred for nasal CPAP trials agreed to home therapy. Forty-eight of these 68 patients were compliant at 3.5 months’ mean follow-up. In this instance, only 48 (47 percent) of 103 patients with OSA were eventually able to comply with home nasal CPAP.

A more detailed analysis of our noncompliant pa­tients revealed that 40 percent had discontinued therapy within the first two months, 66 percent by six months, and 87 percent of these patients (20 of 23) were noncompliant in the first year. tadalis sx

A majority of patients reported some adverse reac­tion with nasal CPAE However, there was no signifi­cant difference in the overall frequency or variety of side effects between the compliant and noncompliant groups. Both groups also demonstrated equally dra­matic improvements in sleep-disordered breathing during nasal CPAP trials. Noncompliant patients, therefore, were not more apt to have had an incomplete response to therapy.

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