The 44 patients (39 men and 5 women) were, on average, 58 years old (range, 40 to 82 years) and had a mean body mass index (BMI) of 34.9 ± 8.02 kg/m2. Heart disease was diagnosed in 39 percent (17) of the patients, and 70 percent (31) of the patients were receiving antihypertensive treatment. The initial examination consisted of an exploration of respiratory function and a polysomnographic recording. Sleep stages were distinguished between light sleep (stages 1 and 2) and slow-wave sleep (stages 3 and 4) according to the criteria of Rechtschaffen and Kales. The mean AH I was 52 ± 24. Treatment with CPAP was started during the second night of polysomnography to determine the level of effective positive airway pressure required to stop snoring, apnea, and desaturation. The mean level of effective positive pressure was 9.68 ± 2.68 cm H20.
All patients were initially equipped with a standard mask and instructed in the use of it at the Department of Pneumology over a period of 48 h. The patients were seen again 1 week later and at the end of the first month of use, in order to ensure their appreciation of CPAP efficiency and tolerance. A mask was occasionally molded in case of nasal erosion, and advice was given in order to increase the daily use of nasal CPAP. A new study was made every 6 months, and in the meantime the patients were visited at home by a technician who checked the time counter and made sure that the CPAP was working. buy birth control
Diurnal hypersomnia was analyzed initially from data obtained at the first consultation and afterwards was analyzed every 6 months, with the same questionnaire for all of the patients. The degree of sleepiness was quantified as a function of the number of “yes” answers (hypersomnia score) to the following 6 questions (progressive shades between “yes” and “no” for each answer were not taken in account): (1) tired in the morning after getting up; (2) lapse of attention while reading a book or watching television; (3) falling asleep under any circumstance; (4) lapse of memory; (5) fighting sleep during the day; and (6) nap after lunch. The evolution of diurnal hypersomnia was determined from the difference between the initial score and the score at the end of the study.
The compliance with treatment was estimated on the basis of the average length of time that the apparatus was used each day (determined using a time counter) and by the frequency of use, based on the patient’s statement. Compliant patients were thus defined as those who used the apparatus for a mean of over 5 h per night, combined with regular use throughout the night every night.
The Wilcoxon signed-rank test was used to compare the AHI, hypersomnia score, and sleep stages before and with nasal CPAP. A correlation analysis was performed with the Spearman coefficient. Two-tailed p values below 0.05 were considered significant.