Long-term Compliance with Nasal Continuous Positive Airway Pressure Therapy: 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 at a single point in time in November 1987. Those patients still ising nasal CPAP at that time were designated “compliant” and :hose who had discontinued therapy were “noncompliant.”  The following parameters in the compliant and noncompliant patients were compared at presentation and after the initial nasal CPAP trial: age, sex, weight, severity of daytime sleepiness, apnea plus hypopnea index (AHI), sleep stages, and minimum nocturnal oxygen saturation (SaOJ. The presence of severe daytime sleepiness prior to therapy was assessed by review of charts and sleep history questionnaires obtained at the time of the diagnostic polysomnogram. At the time of follow-up patients were asked to retrospectively quantitate the severity of their daytime sleepiness compared with their pretreatment level of daytime sleepiness according to a scale described by Sink et al. Patients were asked to grade their symptoms (feeling sleepy or struggling to stay awake in the daytime) on a scale from 1 to 5, where l = none, 2 = slight, 3 = moderate, 4=fairly severe, and 5 = very severe. Subjects who answered 4 or 5 were said to be “positive” for severe daytime sleepiness, whereas those who answered 1, 2, or 3 were said to be “negative” for severe daytime sleepiness. Sleep architecture was analyzed by comparing the percentages of stage 1 plus 2, stages 3 plus 4, and rapid eye movement (REM) sleep, respectively, with and without nasal CPAP in the compliant and noncompliant patients.

Adverse reactions to home nasal CPAP and a history of previous palatal surgery in the two groups were also compared. Nasal CPAP pressure levels and duration of therapy in the two groups were recorded. All patients underwent baseline diagnostic polysomnog­raphy and a repeat sleep study with nasal CPAP in our laboratory. Patients received instruction from a sleep center physician regarding the application and maintenance of the device. A follow-up home visit was provided by a respiratory care company on initiation of home therapy. The SleepEasy nasal CPAP system (Respironics Inc, Monroeville, Pa) was used in all patients in the laboratory and at home.
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