Factors predicting CPAP adherence in obstructive sleep apnea syndrome

Riachy, Moussa; Najem, Samer; Iskandar, Mirella; Choucair, Jad; Ibrahim, Ihab; Juvelikian, Georges

doi:10.1007/s11325-016-1408-y

Cited by 51 publications

(37 citation statements)

References 30 publications

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“…Median adherence time was 957 days. It also highlighted an adherence of 70.3% at 6 months and 49.3% at 8 years [3].…”

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confidence: 85%

“…Each contact with the service provider reduced the risk of non-adherence to CPAP by 18% (HR = 0.847), marking the importance of a patient support program that could promote education on the optimal use of the CPAP. Spouse encouragement plays also an important role [3]. This was highlighted in a meta-analysis by Wozniak et al [8] that showed that support interventions were linked to slightly better adherence.…”

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confidence: 99%

“…Among the factors that were found to affect adherence to CPAP, Riachy et al [3] found a faster short term (first 3 months) followed by a slower long term dropped out. The identification of true predictors of adherence to CPAP, independent of the best provider care, is of such great importance since it helps optimize the care of OSA patients with a more customized approach [1].…”

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confidence: 99%

“…The risk of non-adherence is reduced by 5.5 times compared to renting it. There are several postulates for this influence including the patient's conviction of long-term need for the device in order to maximize benefits both symptomatically and physiologically [3]. In addition, the number of follow-up contacts by the provider, and self-reported improvement on treatment were positive predictors of long-term adherence.…”

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confidence: 99%

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Promoting CPAP adherence in obstructive sleep apnea

Riachy¹

2017

Pulm Crit Care Med

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Continuous positive airway pressure (CPAP) remains the gold standard therapeutic intervention in obstructive sleep apnea (OSA) [1]. Significant adherence issues with CPAP (defined as device use for <4 hours/night)`, reported to range from 29-83% in OSA patients`, decrease its effectiveness in long-term therapy [2].In a cohort study conducted at the Sleep Center of Hôtel-Dieu de France Hospital in Lebanon over 8 years, the CPAP adherence was studied. Median adherence time was 957 days. It also highlighted an adherence of 70.3% at 6 months and 49.3% at 8 years [3].Among the factors that were found to affect adherence to CPAP, Riachy et al. [3] found a faster short term (first 3 months) followed by a slower long term dropped out. The identification of true predictors of adherence to CPAP, independent of the best provider care, is of such great importance since it helps optimize the care of OSA patients with a more customized approach [1]. This could help in developing individualized plans for different patients' profiles in order to optimize CPAP adherence at each moment of the follow-up of his treatment.In the beginning of the CPAP treatment, the oxygen desaturation index (ODI) increase of 10 per hour at baseline was associated with a 20% decrease in the risk of short-term CPAP non-adherence (HR = 0.98). This decrease is consistent with the results of Kohler et al. [4]. In contrast to our results, McArdle et al. [5] showed that it was rather the daytime sleepiness (ESS) at diagnosis that affected short-term adherence.The use of a nasal mask reduced the risk of non-adherence by 50% with an HR of 0.48. Therefore, suggesting a nasal mask preferentially in patients starting CPAP appears warranted and justified [6,7].On the long term, buying the CPAP device in a health system that emphasizes the patient participation seems to play an important role in adherence to treatment. The risk of non-adherence is reduced by 5.5 times compared to renting it. There are several postulates for this influence including the patient's conviction of long-term need for the device in order to maximize benefits both symptomatically and physiologically [3]. In addition, the number of follow-up contacts by the provider, and self-reported improvement on treatment were positive predictors of long-term adherence. Each contact with the service provider reduced the risk of non-adherence to CPAP by 18% (HR = 0.847), marking the importance of a patient support program that could promote education on the optimal use of the CPAP. Spouse encouragement plays also an important role [3]. This was highlighted in a meta-analysis by Wozniak et al. [8] that showed that support interventions were linked to slightly better adherence.Long-term adherence to CPAP is related to the patient's weight change on diet. Our study showed that patients on a diet plan were 4.8 times more likely to stop using the CPAP. This could be interpreted by an improvement of the OSA symptoms after weight loss even without a complete recovery from the underlying condition. References

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“…Median adherence time was 957 days. It also highlighted an adherence of 70.3% at 6 months and 49.3% at 8 years [3].…”

mentioning

confidence: 85%

mentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Promoting CPAP adherence in obstructive sleep apnea

Riachy¹

2017

Pulm Crit Care Med

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To the editor, We have a great interest in the recently published article entitled BFactors predicting CPAP adherence in obstructive sleep apnea syndrome^by M. Riachy et al [1]. The authors studied the determinants of short-term and long-term CPAP adherence in a group of Lebanese patients.

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Intervention for CPAP adherence in OSAS: a choice to patient or technique?

Esquinas

2017

Sleep Breath

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To the editor, We have a great interest in the recently published article entitled BFactors predicting CPAP adherence in obstructive sleep apnea syndrome^by M. Riachy et al. [1]. The authors studied the determinants of short-term and long-term CPAP adherence in a group of Lebanese patients. However, we have some drawbacks for the aforementioned article for proper clinical explanations.First, patient enrollment did not follow a strict physiologic and demographic criterion. In this regard, the text lacks demographical features of the patients. Authors did not compare body mass index (BMI) for continuous positive airway pressure (CPAP) adherence. Especially for morbid obese patients with obstructive sleep apnea (OSA), level of oxygen desaturation due to hypoventilation continues despite efficacy of CPAP therapy. In this group of patients, significant hypoxemia observed during the day and CPAP therapy failure is greater that non obese OSA [2].Second, authors did not clarify patient's daytime sleepiness and hypoxemia and implications of their results described. It is a well-known fact that CPAP adherence rate is highest in patients with excessive daytime sleepiness and severe hypoxemia. Patients with excessive daytime sleepiness, but not have severe hypoxemia, had less CPAP adherence than patients with hypoxemia without excessive daytime sleepiness (55 and 70%). The best indicator of CPAP adherence is hypoxia [3]. This association needs to take into account by authors.Third, we could not see the data about tolerance and complications due to mask. Nasal complications as skin irritation and dermatitis, conjunctivitis developed due to air leak from mask, and the other factors affects mask usage and CPAP adherence. These data needs to be addressed properly in the study. We consider that prior to the start of CPAP therapy, identification of the risk group for less CPAP compliance could provide early integration of basic education and behavior support as well as factors of facilitation such as automatic CPAP [4].We conclude that simple and inexpensive efforts to improve compliance of CPAP therapy could be effective, especially when applied at the start of CPAP therapy. Optimal interventions may vary with certain patient characteristics. Compliance with ethical standardsConflict of interest The authors declare that they have no conflict of interest.

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