Title: Determinants Of CPAP Compliance In Newly Diagnosed ...
Title: Determinants Of CPAP Compliance In Newly Diagnosed Previously Untreated Obstructive Sleep Apnea Patients
Authors: Ravi U Pande, MD, MS, Margaret Paroski, MD, Janet Shucard, Ph.D, Daniel I Rifkin, MD
Introduction: Nasal continuous positive airway pressure (CPAP) is the gold standard treatment of obstructive sleep apnea syndrome (OSAS). However, the benefits of CPAP rely on regular use of the therapy by the patient, which in turn depends on several social, mechanical, economical and demographical factors. The compliance of Americans to CPAP reportedly ranges from 4.7 to 5.3 hours/night ((h/n), which is much less than many European countries. Many previous studies have focused on compliance variables like severity of disease, side effects and health benefits, but ignored sleep parameters as the predictors of compliance. The aim of this study was to 1) assess the CPAP compliance in Buffalo Metropolitan area and 2) investigate any possible association of the polysomnogram (PSG) variables with objective CPAP compliance.
Methods: A retrospective chart review was performed on 141 random patients whose short term (2.5 month) CPAP compliance data were available. The final sample consist of 80 patients with newly diagnosed and previously untreated OSA (rest excluded due to history of previous diagnosis of OSA and/or treatment CPAP).
Results: Among the 80 newly diagnosed OSAS patients (43 men and 37 women), mean age was 51.14 ± 12.4 years and mean weight was 213.44 ± 47.07 lbs. The CPAP compliance was an average of 5.95 hours/night (h/n). Comparison between non compliant group (NCG) of 26 patients (who used CPAP for >4 h/n for ≤50% of the nights) and compliant group (CG) of 54 patients (who used the CPAP >4 h/n for >50% of the nights) showed that NCG had a trend toward lower ESS [p=0.15], higher sleep efficiency [p=0.18], and lower RDI [p=0.08] as compared to the CG. A significant difference was found between the two groups in respiratory arousal index (RAI) [p=0.008]. Mild, but significant positive correlation was found between the CPAP compliance and RAI on Pearson’s scale (r=0.295, p = 0.008).
Conclusion: In newly diagnosed previously untreated patients with OSAS, 1) short term compliance to CPAP was an average of 5.95 h/n and 2) higher RAI were indicative of higher CPAP compliance during short term follow up. Respiratory arousal index may
be an important overlooked predictor of CPAP compliance.
Disclosure: None
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