Compliance with continuous positive airway pressure therapy in patients with sleep apnea/hypopnea syndrome

Gallego, C.W.; Dibur, E.; Salomone, César.; Di Bartolo, C.G.

Medicina 64(5): 395-399


ISSN/ISBN: 0025-7680
PMID: 15560539
Accession: 011889576

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Compliance with continuous positive airway pressure therapy in patients with sleep apneal hypopnea syndrome. Predictive factors and compliance level were evaluated in a group of patients with sleep apnea syndrome under CPAP treatment, assessing side effects and equipment condition: silicone interface (SI), mask-conectors (M-C), air tube (AT) and head strap (HS). Patients with >3mo treatment were included, clock counter reading was registered at the beginning, 2 and 4 mo. Patients were considered compliant (C+) when usage was >4h/day and >5day/week. Of 46 patients (male 34; age 62 +/- 9years; BMI 33 +/- 7kg/m2; AHI 38 +/- 18/h; time of therapy 2.1 +/- 1.7 years; CPAP 9 +/- 1.4 cmH2O), 34 had a clock counter and 24 (71%) were C+. Initial symptoms included: somnolence (65%), snoring (39%), bed-partner witnessed apneas (28%). Comparing C+ y C- we didn't find significant difference in age, BMI, CPAP pressure, length of therapy, AHI and pre-treatment Epworth classification. Referred vs. measured time of use in C+ and C- were 6.6 +/- 1 vs. 6.1 +/- 1 h/d (p=0.02) y 5.6 +/- 1 vs. 2.4 +/- 1 h/d (p<0.005). Compliant patients reported more resolution of somnolence (p<0.005) and nocturia (p<0.05), lower post CPAP Epworth (p<0.05), more frequent somnolence as initial symptom (p<0.05) and a higher education level (p=0.01). Side effects (SE) (n=45): dry mouth 36%, nasal congestion 27%, sleep disruption 11%, CPAP noisy 9%, dry nose, rhinorrhea and skin irritation 7%. Twenty seven percent of patients reduced the CPAP use because of the SE. Correction strategies included: humidifier, nasal steroid, surgery or infiltration of turbinates. Comparing the condition of SI, M-C, AT and HS between 51 vs. >1 year of use, we observed a lower percentage of fine elements (87 to 44%, 74 to 44%, 83 to 44%, 91 to 78%, respectively). Most common defects included stiffness of SI, cracks in SI, M-C and AT, loose conexions. The study confirms the importance of objective monitoring in patients with CPAP. Side effects and equipment condition require special attention because this could affect an effective treatment.