Long-term Acceptance of Continuous Positive Airway Pressure in Obstructive Sleep Apnea

Rolfe, Isobel; Olson, L. G.; Saunders, Nicholas A.

doi:10.1164/ajrccm/144.5.1130

Cited by 170 publications

(104 citation statements)

References 6 publications

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“…Pretreatment Epworth score and other measures of subjective daytime sleepiness are established predictors of CPAP compliance [12,22,23]. The reason that a short diagnostic TST leads to better long-term use may be because this allows a longer time for CPAP titration, which may lead to a more accurate CPAP determination [24].…”

Section: Discussionmentioning

confidence: 99%

“…However, a typical pattern of oxygen desaturation is associated with a shorter diagnostic TST, presumably because this makes it easier for the night nurses to decide to start CPAP titration. A shorter diagnostic TST may lead to better long-term use because oxygen desaturation is a marker of disease severity and a predictor of CPAP compliance [22,25].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Split-night versus full-night studies for sleep apnoea/hypopnoea syndrome

McArdle¹,

Grove²,

Devereux³

et al. 2000

Eur Respir J

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Investigation and treatment of sleep apnoea/hypopnoea syndrome (SAHS) is placing increasing demands on healthcare resources. This workload may be reduced by using split-night studies instead of the standard full-nights of diagnostic polysomnography and continuous positive airway pressure (CPAP) titration. Splitnight studies involve polysomnography in the first half of the night followed, if there is an abnormal frequency of apnoeas and hypopneas, by CPAP titration for the remainder of the night.The authors' database of all patients prescribed a CPAP trial 1991±1997 was used to compare long-term outcomes in all 49 (46 accepting CPAP) patients prescribed split-night studies with those in full-night patients, matched 1:2 using an apnoea/ hypopnoea index (AHI) of 15% and Epworth score of 3 units.Classical symptoms of SAHS were the main reason for the split-night studies (n=27). There were no differences between the groups in long-term CPAP use, median nightly CPAP use (split-night 6.0 h . night -1 , interquartile range (IQR) 3.8±7.4, fullnight; 6.2 h . night -1 , IQR 3.7±7.0, p=0.9), post-treatment Epworth scores and frequency of nursing interventions/clinic visits required. The median time from referral to treatment was less for the split-night patients (13 months, IQR 11±20 months) than for full-night patients (22 months, IQR 12±34 months; p=0.003).Split-night studies, in selected patients, result in equivalent long-term continuous positive airway pressure use to full-night studies with shorter treatment times and less healthcare utilization. Eur Respir J 2000; 15: 670±675. Sleep apnoea/hypopnoea syndrome (SAHS) is a common condition, affecting 2±4% of the middle-aged population [1]. The consequences of SAHS include daytime sleepiness, altered mood and impaired cognitive function [2,3] leading to reduced quality of life [4,5] and an increased risk of accidents at work and on the road [6±8]. Many sleep centres are struggling to cope with the number of patients being referred and the financial restrictions placed on their investigation. One way of reducing the time taken to investigate and treat patients is to use splitnight studies whereby diagnostic polysomnography and continuous positive airway pressure (CPAP) titration are accomplished on the same night rather than the standard two nights consisting of a diagnostic polysomnography night and subsequent CPAP titration night (full-night patients).Despite the potential savings, split-night studies are not widely used in all countries, at least partly because of concerns about the unknown long-term outcome of these studies [9]. The few evaluations that have included clinically relevant outcomes have not used a control group [10], or, when a control group was used, the numbers were small (n=12, in each group) and the outcome evaluation was limited to mean nightly CPAP use at the initial clinic visit [11]. Therefore, a larger scale study of the value of split-night studies was performed. MethodsUsing the authors' database of 1,211 patients booked for CPAP tit...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Split-night versus full-night studies for sleep apnoea/hypopnoea syndrome

McArdle¹,

Grove²,

Devereux³

et al. 2000

Eur Respir J

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“…Despite improvements in nCPAP devices, long-term compliance in patients under nCPAP therapy has varied from 45 to 90% [15][16][17][18][19]. There are many reasons why patients may not tolerate nCPAP.…”

Section: Discussionmentioning

confidence: 99%

“…There are many reasons why patients may not tolerate nCPAP. A number of minor side-effects related to a fixed high level of nasal pressure [3] have been reported, including: discomfort due to the mask; rib cage discomfort; difficulty in breathing against the machine; soreness and/or dryness of the nose, mouth or throat; nasal congestion; and poor sleep due to mask leaks and noise generated by the device [15][16][17][18][19]. To reduce the overnight mean nasal pressure value, new nCPAP devices that automatically and rapidly adjust the pressure to the minimal effective level have recently been developed.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of an auto-nCPAP device based on snoring detection

Lofaso¹,

Lorino²,

Duizabo³

et al. 1996

Eur Respir J

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E Ev va al lu ua at ti io on n o of f a an n a au ut to o--n nC CP PA AP P d de ev vi ic ce e b ba as se ed d o onWe observed that a single night of auto-nCPAP improved the apnoea/hypnoea index (AHI) (12±21 vs 51±31 disordered breathing events·h -1 of sleep (mean±SD)), the awakening-arousal index (13±20 vs 40±26 arousals·h -1 of sleep), and duration of slow wave sleep (102±49 vs 71±56 min) but not of rapid eye movement (REM) sleep (55±31 vs 64±38 min). Auto-nCPAP was effective (apnoea/hypopnoea and arousal indices <10 events·h -1 ) in all but three patients. Auto-nCPAP was ineffective in one patient, whose obstructive respiratory events were not preceded by nasal mask pressure vibration detection, and in two patients who were quasi-permanent mouth breathers.Snoring detection may be effective in sleep apnoea syndrome with heavy snoring and without permanent mouth breathing, during the first night of nasal continuous positive airway pressure treatment.

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“…Third, other OSA-related complaints and symptoms (snoring, fatigue, breathing pauses and choking) were not considered. Fourth, this study was conducted in a health system where CPAP treatment has no cost to the patient; thus, we cannot exclude that cost could be a determinant of compliance in systems where treatment is not free, even though the available data argue against a significant effect of cost on continued use (32).…”

Section: Strengths and Limitationsmentioning

confidence: 99%