Long-term Compliance with Nasal Continuous Positive Airway Pressure Therapy: RESULTS part 2

Airway Pressure

The mean level of nasal CPAP prescribed did not differ in the compliant and noncompliant groups (10.6 ±2.6 cm HaO for each group). Seventy (96 percent) of the 73 compliant patients used nasal CPAP nightly. One compliant patient did not use CPAP on weekends and two patients used CPAP on alternate nights. Therefore, all compliant patients used nasal CPAP at least four of seven nights. When questioned about time of use per night, every compliant patient reported CPAP use for at least all but two hours of sleep time. The mean duration of therapy in the compliant group was 14.5 ±10.7 months compared with 6.2 ±7.1 months in those noncompliant (p<0.05, Students t test). Mean duration of therapy was not significantly different in noncompliant patients with previous UPPP compared with other noncompliant patients. Change in weight while receiving nasal CPAP therapy was not significantly different in the two groups (- 3.39 ± 8.3 kg vs – 7.2 ± 10.8 kg).

A high percentage of both groups noted some adverse reaction to home nasal CPAP therapy. Table 4 lists the frequency and type of adverse reactions in both groups. The most common problem in both groups was discomfort related to the nasal CPAP mask. Problems with air leak, inability to keep the mask in place for the duration of the night, and pressure discomfort from the tight fit of the mask were included in this category. Oral and nasal mucosal drying despite supplemental humidification, rhinitis, skin rash on contact points, and occasional conjunctivitis were also noted in both groups. There was one death in a compliant female patient who had been receiving nasal CPAP therapy for 18 months prior to her death. According to her physician and family, she died in her sleep while receiving nasal CPAP with no apparent dysfunction of the system. The cause of her death was not determined. There was also a death during sleep in a male patient who was noncompliant after two months with home nasal CPAP therapy. According to the family, the patient died shortly after discontinuing therapy but the cause of death was not determined.
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Table 4—Adverse Reactions to Nasal CPAP

Compliant
(%)

Noncompliant
(%)

n = 73

n = 23

Adverse Reactions

63(86)

21 (91)

Mask discomfort

37 (51)

15(65)

Dry nose/throat

24(33)

11 (48)

Rhinitis

31(42)

7(23)

Rash

18 (25)

1(4)

Eye irritation

12 (16)

5(23)

Noise/spouse
disruption

10 (14)

4(17)

Belching

6(8)

1(4)

Chest discomfort

7(3)

1(4)

There were 20 patients in the total group who had previously undergone UPPP These patients were equally divided between the compliant and noncompliant groups, representing 14 percent and 43 percent of each group, respectively. The age, sex distribution, baseline AHI, baseline minimum Sa02, rate of adverse reactions, and CPAP pressure in the compliant and noncompliant with a history of previous UPPP were not significantly different. The only variable distin¬guishing compliant and noncompliant patients with UPPP was the severity of daytime sleepiness. All ten patients in the compliant group complained of severe daytime sleepiness compared with five of ten in the noncompliant group (p<0.05, Fishers exact test).

Of the 23 noncompliant patients, 11 patients sought no further treatment, five underwent UPPP or revision of previous surgery, three underwent tracheostomy or opening of a closed tracheostomy, two achieved a significant weight reduction, and one was fitted with a mandibular advancing dental device. There was one death in this group. cialis super active

The relation of age and sex to compliance with home nasal CPAP therapy was also examined. Twenty- three patients of the 96 receiving home nasal CPAP therapy were 60 years or older. Seventy-eight percent of these patients were compliant. Of the group from 40 to 60 years of age, 77 percent (35 of 45) were compliant. Patients younger than 40 years had a 70 percent compliance rate (14 of 20). Twelve (80 percent) of the 15 women patients with OSA were compliant at follow-up compared with 61 (75 percent) of the 81 male patients.

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