Investigating the parameters that affect first night CPAP adherence

Patients with sleep apnea are usually treated with continuous positive airway pressure (CPAP). This therapy is very effective if the patient′s adherence is satisfactory. However, although CPAP adherence is usually acceptable during the first months of therapy, it progressively decreases, with a considerable number of patients accepting average treatment duration below the effectiveness threshold (4 h/night). Herein, our aim was to describe and evaluate a novel telemedicine strategy for rescuing CPAP treatment in patients with low adherence after several months/years of treatment. This two-week intervention includes (1) patient support using a smartphone application, phone and voice recorder messages to be answered by a nurse, and (2) daily transmission and analysis of signals from the CPAP device and potential variation of nasal pressure if required. On average, at the end of the intervention, median CPAP adherence considerably increased by 2.17 h/night (from 3.07 to 5.24 h/night). Interestingly, the procedure was able to markedly rescue CPAP adherence: the number of patients with poor adherence (<4 h/night) was considerably reduced from 38 to 7. After one month, adherence improvement was maintained (median 5.09 h/night), and only 13 patients had poor adherence (<4 h/night). This telemedicine intervention (103€ per included patient) is a cost-effective tool for substantially increasing the number of patients with CPAP adherence above the minimum threshold for achieving positive therapeutic effects.

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P033 Randomised controlled trial on the efficacy of Audio-visual Health Educational materials on CPAP ADherence: The AHEAD trial

SLEEP Advances ◽

10.1093/sleepadvances/zpab014.081 ◽

2021 ◽

Vol 2 (Supplement_1) ◽

pp. A32-A32

Author(s):

C Ellender ◽

C Samaranayake ◽

B Duce ◽

M Boyde ◽

S Winter ◽

...

Keyword(s):

Health Literacy ◽

Low Cost ◽

Controlled Trial ◽

Standard Of Care ◽

Eligibility Criteria ◽

Cpap Adherence ◽

Low Health Literacy ◽

Significant Difference ◽

Educational Videos ◽

Video Education

Abstract OSA is a prevalent chronic disease with significant health implications, for which achieving >4 hours/night on continuous positive airway pressure (CPAP) is essential for effective treatment. Educational videos to improve CPAP adherence are of interest as a low-cost intervention, however trials have shown mixed results. This study aimed to compare CPAP usage following standard of care education (SOCE), with the usage following the addition of educational videos, customised to incorporate low health literacy communication, motivational and self-efficacy techniques. Methods Adults with OSA recommended treatment with CPAP, were recruited and randomised in a single blinded method, to watch short educational videos following their in laboratory CPAP study or SOCE. The primary outcome was CPAP usage at 2mths and secondary outcomes were usage at 12mth and proportion of patients with adequate usage >4hrs/night. Results 195 patients met the eligibility criteria and were randomised to video education (n = 96) or to SOCE (n = 99). There was no significant difference in compliance at 2mths (median usage 1.7hrs IQR 0–6.2 SOCE, 4.4hrs IQR 0–6.7 video education p = 0.1), however at 12mths there was increased usage in the video education arm (median 0hrs IQR 0–5.4 standard of care, 3.8hrs IQR 0–6.87 p = 0.05). The proportion with adequate CPAP usage >4hrs/night at 12mths was higher in the video education group (33, 33% versus 48, 50% p = 0.01). Conclusions Long-term adherence to CPAP is enhanced by the addition of educational videos that incorporate low health literacy communication and motivational techniques, compared to SOCE.

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P139 Co-morbid insomnia and sleep apnoea (COMISA): Identifying patients that are responsive to continuous positive airway pressure therapy

SLEEP Advances ◽

10.1093/sleepadvances/zpab014.180 ◽

2021 ◽

Vol 2 (Supplement_1) ◽

pp. A66-A67

Author(s):

A Sweetman ◽

L Lack ◽

S Smith ◽

C Chai-Coetzer ◽

P Catcheside ◽

...

Keyword(s):

Continuous Positive Airway Pressure ◽

Airway Pressure ◽

Positive Airway Pressure ◽

Sleep Apnoea ◽

Controlled Study ◽

Cpap Therapy ◽

Pressure Therapy ◽

Cpap Adherence ◽

Insomnia Severity

Abstract Introduction Co-morbid insomnia and sleep apnoea (COMISA) is a prevalent and debilitating condition that is difficult to treat. COMISA patients have lower average adherence to continuous positive airway pressure (CPAP) therapy compared to patients with sleep apnoea alone. However, a sub-sample of COMISA patients may show adequate CPAP use that improves both the insomnia and sleep apnoea. It is important to identify this group of CPAP-responsive COMISA patients to guide personalised-medicine approaches. Methods Seventy-three COMISA patients (AHI≥15; ICSD-3 insomnia; 55% male, Age M=57y) completed questionnaires, home-based polysomnography, and one-week sleep diaries before and 6-months after commencing CPAP therapy. No patients accessed CBTi. We investigated baseline predictors of CPAP adherence (min/night) and overall change in Insomnia Severity Index (ISI) scores during treatment. Results Average CPAP adherence was 205 minutes/night (SD=153). 56% of patients used CPAP at least 4h/night. Average CPAP adherence was predicted by higher baseline AHI (r=0.39), arousal index (r=0.28), N1 sleep (r=0.32) and age (r=0.26), and lower N3 sleep (r=-0.28). The ISI decreased from baseline (17.9, CI=1.2) to 6-month follow-up (11.6, CI=1.3; p<0.001). There was a significant positive association between ISI reduction and CPAP use (r=0.31). 26% of patients reported an ISI<8 at 6-month follow-up. Conclusion Approximately half of COMISA patients show CPAP adherence of ≥4h/night and one quarter experience insomnia remission with CPAP. CPAP use is positively associated with AHI, light sleep, and age at baseline, and reduction of insomnia severity during treatment. Future randomized controlled trials are required to confirm the results of this small un-controlled study.

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Is Prediction of CPAP Adherence in Obstructive Sleep Apnea in the Perioperative Setting Feasible?

Journal of Clinical Sleep Medicine ◽

10.5664/jcsm.2856 ◽

2013 ◽

Vol 09 (07) ◽

pp. 731-731

Author(s):

Antonio M. Esquinas ◽

Peter Cistulli

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Cpap Adherence ◽

Obstructive Sleep

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The effect of non-benzodiazepine sedative hypnotics on CPAP adherence in patients with OSA: a systematic review and meta-analysis

SLEEP ◽

10.1093/sleep/zsab077 ◽

2021 ◽

Author(s):

Donghao Wang ◽

Yongkang Tang ◽

Yanghang Chen ◽

Sun Zhang ◽

Danjie Ma ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Randomized Controlled Trials ◽

Meta Analysis ◽

Cochrane Library ◽

Controlled Trials ◽

Cpap Adherence ◽

Randomized Controlled ◽

Obstructive Sleep ◽

Sedative Hypnotics

Abstract Study objectives This meta-analysis aimed to explore the effect of non-benzodiazepine sedative hypnotics (NBSH) on continuous positive airway pressure (CPAP) adherence in patients with obstructive sleep apnea (OSA). Methods We conducted a systematic search through PubMed, Medline, the Cochrane Library, EMBASE, Scopus and ClinicalTrials (all searched from inception to 15 August 2020). Publications were limited to articles, clinical conferences and letters, including randomized controlled trials and retrospective studies. We used a random-effects model to calculate the odds ratio (OR) and mean difference (MD) with corresponding confidence interval (CI). Subgroup analyses were conducted to analyze the sources of heterogeneity. Results Eight studies fulfilled the inclusion and exclusion criteria for patients newly diagnosed with obstructive sleep apnea. Overall, the use of NBSH was associated with increased use of CPAP per night (MD = 0.62 h; 95% CI = 0.26-0.98) and use for more nights (MD = 12.08%; 95% CI = 5.27-18.88). When a study seriously affecting heterogeneity was removed, more patients adhered well with CPAP use (pooled OR = 2.48; 95% CI = 1.75-3.52) with good adherence defined as CPAP use for＞4 h/night on＞70% of nights. Among prescribed NBSHs, eszopiclone showed the most significant effect on CPAP adherence. Conclusion CPAP adherence may increase in OSA patients treated with non-benzodiazepine sedative hypnotics especially eszopiclone. The effect of zolpidem and zaleplon on CPAP adherence requires further investigation by larger scale, randomized, controlled trials.

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0653 Positive Effects of Long Term Continuous Positive Airway Pressure Therapy on Blood Pressure in Obstructive Sleep Apnea Patients

SLEEP ◽

10.1093/sleep/zsaa056.649 ◽

2020 ◽

Vol 43 (Supplement_1) ◽

pp. A249-A249

Author(s):

R Shirahama ◽

T Tanigawa ◽

K Tomooka ◽

L Fan Yun ◽

A Ikeda ◽

...

Keyword(s):

Blood Pressure ◽

Weight Loss ◽

Obstructive Sleep Apnea ◽

Continuous Positive Airway Pressure ◽

Airway Pressure ◽

Positive Airway Pressure ◽

Cpap Therapy ◽

Significant Weight Loss ◽

Cpap Adherence ◽

Obstructive Sleep

Abstract Introduction Obstructive sleep apnea (OSA) is one of the common causes of hypertension. Therefore, we examine the longitudinal effect of continuous positive airway pressure (CPAP) therapy and its adherence on blood pressure among OSA patients. Methods One thousand two hundred ninety-three (male 1,130, female 163) patients, who were diagnosed with OSA and underwent CPAP therapy were investigated for longitudinal changes (24 months observation period) in the levels of blood pressure and body weight. The longitudinal analyses were performed by mixed effect model. Multiple Imputation with Chained Equations was also used to impute missing data. Good CPAP adherence is defined as more than 70% of the time using CPAP more than 4hours at all the measuring. Poor CPAP adherence is defined as less than 70% of the time using CPAP more than 4hours at all the measuring time points. Results The patient group with good CPAP adherences), compared to poor CPAP adherence, showed significant diastolic blood pressure reduction in 24 months follow-up period (β=-0.13, p=0.03) despite a lack of significant weight loss (β=-0.02, p=0.59). However, no significant associations were found between systolic blood pressure and CPAP adherence (β=-0.14, p=0.11). Conclusion CPAP therapy was found to have a longitudinal effect on diastolic blood pressure despite a lack of significant weight loss. Support

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The Effect of OSA Severity and CPAP Adherence on Weight Regain After Bariatric Surgery

10.1164/ajrccm-conference.2020.201.1_meetingabstracts.a2439 ◽

2020 ◽

Author(s):

B.W. Locke ◽

J. Kim ◽

J. Bennion ◽

C. Prasad ◽

E. Volckmann ◽

...

Keyword(s):

Bariatric Surgery ◽

Weight Regain ◽

Cpap Adherence

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0683 CPAP Adherence Relative To Sleep Duration And Sleep Period In Different Study Populations

SLEEP ◽

10.1093/sleep/zsaa056.679 ◽

2020 ◽

Vol 43 (Supplement_1) ◽

pp. A260-A261

Author(s):

S Deering ◽

T Shumard ◽

T Zamora ◽

S Martinez ◽

C J Stepnowsky

Keyword(s):

Pittsburgh Sleep Quality Index ◽

Total Sleep Time ◽

Total Sample ◽

Sleep Time ◽

Overlap Syndrome ◽

Clinical Population ◽

Sleep Period ◽

Cpap Adherence ◽

Combined Data ◽

Do So

Abstract Introduction CPAP is intended for use during sleep to alleviate disordered breathing. Most patients who use CPAP do so for only a portion of their sleep period, although anecdotally it is known that some also use CPAP while awake. We compared the unusually high levels of CPAP adherence found in a recent study of patients with Overlap Syndrome to a VA clinical population and to participants from the APPLES study. Methods CPAP adherence levels were taken from three sources: (1) The O2VERLAP Study, a large comparative effectiveness trial that used two different methods of providing information and support to current CPAP users diagnosed with both OSA and COPD. (2) Combined data from the four most recent clinical CPAP trials conducted at VA San Diego Healthcare System. (3) The APPLES study. Total sample sizes were 332, 957, and 405, respectively. Total sleep time (TST) and total sleep period (TSP) were assessed via the Pittsburgh Sleep Quality Index (PSQI) for (1) and (2) and via polysomnography for (3). Results Mean CPAP use, TST, and TSP for each source were: (1) 6.7, 6.8, & 8.1; (2) 4.0, 6.1, & 7.5; (3) 4.5, 6.6, & 8.0. We examined the ratios of adherence over either TST or TSP, and the ratios for each source were: (1) 98% & 83%; (2) 66% & 55%; (3) 68% & 56%. Conclusion This comparison demonstrates that unlike many CPAP users who tend to use therapy for only a fraction of time spent asleep, patients with COPD and OSA exhibit higher levels of adherence which often exceed sleep time and may be obtaining additional benefits from CPAP use during non-sleep periods. More research is needed both to improve CPAP delivery and support for patients who are using CPAP sub optimally and to understand the factors that account for the heightened levels of CPAP adherence in COPD. Support PPRND #1507-31666; IIR 02-275; IIR 07-163; IIR 12-069; PULM-028-12F.

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