Therapy with nCPAP: incomplete elimination of Sleep Related Breathing Disorder

Abstract

Correct assessment of the overall treatment effectiveness requires knowledge about therapy compliance and efficacy. This study aimed to determine overall long-term apnoea alleviation after continuous positive airway pressure (CPAP) in a complete sleep laboratory cohort.Out of 209 consecutive CPAP candidates (mean age 5712 yrs, body mass index (BMI) 30.05.1 kg . m 2 , respiratory disturbance index (RDI) 32.929 h), follow-up treatment was performed in 149 of them at 9, 18 and 30 months after CPAP prescription. Compliance with CPAP (machine run time/days CPAP available) was adjusted for the individual subjective sleep-time. Apnoea alleviation was defined as adjusted compliance multiplied by the CPAP effect (RDI with CPAP applied), remaining RDI was calculated.The baseline RDI, age or BMI in 75 patients, who did not tolerate nasal continuous positive airway pressure (nCPAP), did not differ from those accepting CPAP (acceptors, n=74). In acceptors at 9 months follow-up RDI with CPAP applied was 1.42.6 (CPAP effect, n=66), mean CPAP use was 3.62.5 . 24 h -1 (n=68), mean apnoea alleviation was 52.432.0% (range 1±100%, n=47), the average remaining wholenight RDI was 17.826. At 9, 18 and 30 months (n=47), the mean daily CPAP use increased from 3.62.5 h to 4.12.5 h and 4.42.4 h (p<0.01).Effectiveness of continuous positive airway pressure is potentially high but acceptance was low. When accounting for sleep-time, its actual effect and use, only 50% adjusted continuous positive airway pressure effectiveness was observed. Eur Respir J 2000; 16: 921±927.

Wrist-actigraphic estimation of sleep time under nCPAP treatment in sleep apnoea patients

“…Another study, concerning patients with mild-tomoderate OSAS, reported a daily use of 3.1 h corresponding to 44 ¡ 34% of declared sleep time [33]. In a more recent study concerning 74 patients with AHI of 35 ¡ 31 treated with nCPAP for 9 months, a daily compliance of 3.6 ¡ 2.5 h corresponded to 56 ¡ 33% of declared sleep time [34]. These studies were based on the hypothesis of equivalence between nCPAP run time and sleep time.…”

A Nasal Cannula Can Be Used to Treat Obstructive Sleep Apnea

“…We acknowledge that obstructive sleep apnea was not completely eliminated in all of our patients, and that nasal CPAP might still be more efficacious in reducing the AHI during treatment nights. Nevertheless, reduced compliance with CPAP can significantly compromise long-term therapeutic effectiveness, leaving a significant portion of patients untreated over time (33). Poor CPAP compliance has been attributed to cumbersome masks, and to difficulties in exhaling against a high backpressure (17).…”

Zonisamide reduces obstructive sleep apnoea: a randomised placebo-controlled study

“…Sleep apnoea alleviation SAA compares the therapeutic effect of CPAP and the drug, taking into consideration absolute use of CPAP (adjusted for habitual sleep time) during the 24-week treatment period [3]. The efficacy of CPAP treatment on AHI or ODI in relation to baseline was first calculated.…”

“…The main consequences of OSA include cardiovascular and metabolic morbidities, and increased daytime somnolence [1,2]. Continuous positive airway pressure (CPAP) constitutes the mainstay of therapy in OSA although long term compliance with the device is incomplete and may be as low as 50% [3]. Therefore, alternative or complementary forms of therapy are actively sought [4,5].…”