Predictive Factors of Long-term Compliance With Nasal Continuous Positive Airway Pressure Treatment in Sleep Apnea Syndrome: Discussion

In order to study the compliance of patients with CPAP, we defined compliance as a function of subjective and objective criteria. To be defined as compliant, patients had to use the apparatus throughout the night every night, for an average duration equal to or greater than 5 h per night (time counter). By applying these criteria, compliance was 68 percent (30 of 44).
The choice of such strict criteria is based on the necessity of preventing oxygen desaturation during sleep, which leads to hemodynamic complications of SAS through associated hypoxemia. This, in fact, recurs as soon as CPAP is stopped and continues throughout the night, thus negating the benefits of the treatment. This is why sleeping without nasal CPAP for more than 1 h per night or alternating its use does not constitute good compliance. Even if the time counter indicated a mean use of over 5 h per night, we cannot be sure that the apparatus was used for more or less than 5 h every night, leading to a possible overestimation of compliance; however, to be included in the compliant group, patients must use CPAP every night, throughout the night without interruption, which confirms that nasal CPAP was regularly used from one night to another (Table 1).
The rate of compliance obtained in this study is relatively low, although the rate is comparable to data in the literature, which range from 63 to 75 percent,’ with the exception of the study by Krieger and Kurtz, which found a level of 90.9 percent. This is directly related to the strictness of our criteria. In fact, when the methods described in the literature are applied to our study to define the level of compliance, completely different results are obtained. mycanadianpharmacy

The majority of studies only take into consideration the numbers of patients who continue to use CPAP over the long term with a level of compliance of 64 to 76 percent, regardless of the average duration or frequency of use. Sanders et al suggest a compliance of 75 percent for all-night use, and Waldhorn et al found a level of 72 percent when patients used the apparatus every night (without a time-counter study). Finally, for Krieger and Kurtz, using the apparatus for over 3 h per night was taken as a reference and gave a compliance level of about 90 percent.
Under these conditions the results of our study are as follows: (1) 97 percent (43) of the patients continued their treatment over the long term, for an average 14 months after beginning treatment; (2) 93 percent (41) of the initial patients used the apparatus every night, and 82 percent (36) used CPAP throughout the night; (3) 86 percent (38) used the treatment for over 3 h per night; and finally, (4) 79 percent (35) of the patients used CPAP throughout the night every night.

This entry was posted in Cavitary Coccidioidomycosis and tagged airway pressure, hypersomnia, positive airway pressure, sleep apnea syndrome, sleep stage.