The good compliance results obtained in our study are partly linked to the way that patients are supervised. Sanders et al found it important to provide good initial training in the use of the apparatus, contrary to the results of Schweitzer et al and of Fletcher and Luckett, who found similar compliance in two groups of patients where one group was well-trained while the other group received neither training nor encouragement during the course of treatment. canada health and care mall
Only 1 patient in our study definitively stopped his treatment after 2 months of use because of major nasal obstruction and rhinorrhea, and this was in spite of the application of various types of local antiinflammatory and decongestant therapy. The percentage of definitive discontinuation of nocturnal ventilation after initial acceptance ranges from 18 to 36 percent, depending on the study in question. The reasons for secondary discontinuation include discomfort caused by the nasal mask and side effects, such as nasal obstruction. The absence of any solid reason for these definitive secondary interruptions in use is frequently described, as is the absence of any subjective effectiveness felt by these patients.
The side effects linked to treatment by nocturnal CPAP are relatively frequent in our study. They mainly concern cutaneous erosion of the bridge of the nose, rhinitis, and leakage, which tends to wake the patient up. The frequency of side effects described in the literature is just as high, because this reaches levels of 86 percent of the cases for Waldhorn and associates. Krieger and Kurtz consider the most frequent limiting factor to be the nasal mask, with a change of mask leading to an increase in the average duration of use. Nasal dryness and obstruction are generally the most frequent complications, reaching a level of 66 percent for Baker et al; however, it is necessary to point out that the frequency of side effects in our study does not impede good use and continuation of treatment over the long term and must not be considered as factors of long-term compliance with treatment.
This study investigated the presence of a significant correlation between the average duration of use, taken from the time counter, and various clinical and paraclinical parameters, both initially and with treatment. There was a highly significant correlation with the initial AHI, as well as with the percentage of light sleep and slow-wave sleep during initial polygraphic recordings. These results demonstrated that the quality of the observance was directly influenced by the initial gravity of SAS, which was characterized by a significant AHI and by sleep perturbation. Patients used their CPAP in proportion to the initial nocturnal troubles, which are the major factors of daytime sleepiness. This is probably one of the reasons for the patients initial acceptance of nasal CPAP.
Long-term observance is most likely conditioned by the quality of the improvement with therapy, because we found an excellent correlation between daily use of nocturnal ventilation with positive airway pressure, and the difference in (1) the AHI, (2) the mean saturation during sleep, and (3) the hypersomnia scores obtained before and after treatment. This shows that compliance is directly linked to a feeling of clinical improvement with treatment, particularly as sleep improves, as indicated by the significant changes in slow-wave sleep and REM sleep obtained with CPAP in our study.
Thus, patients used their apparatus more if they had an initial significant clinical handicap and if they were aware of the beneficial effects of CPAP, leading to an optimal duration of use, regardless of the side effects linked to the treatment. This ensured efficacy and the maintenance of good compliance.