PURPOSE: CPAP is the first line therapy in patients with OSA, however previous studies show poor adherence in up to 50 % of patients after one year .We designed this study to determine if a two week at home patient directed CPAP mask acclimatization intervention prior to starting chronic CPAP therapy will improve early adherence to CPAP therapy.
METHODS: IRB approved prospective randomized, controlled study that included all patients aged >=18 years with newly diagnosed OSA by polysomnogram (apnea hypopnea index, AHI ≥10 events/hour) at a tertiary care hospital over 6 months. Subjects were randomly assigned to intervention/control groups using CDC computerized random number generator system. Both groups underwent mask-selection, sizing and OSA education. Only the intervention subjects received CPAP mask for home and were given instructions on mask acclimatization strategies. At our institution there is a two week wait time for issuance of CPAP equipment. After two weeks both groups received Auto titrating CPAP Therapy and educated on CPAP use at home. After four weeks of home CPAP therapy, adherence of all subjects was assessed. Excessive Daytime Sleepiness was determined by pre and post intervention Epworth Sleepiness Score(ESS).
RESULTS: Total 18 patients were studied (8 intervention group and 10 controls). Both groups were similar in terms of age, gender distribution, BMI, AHI( Mean 27) and RDI(Respiratory Disturbance index). Both groups reported using CPAP for majority of the days (73% for intervention & 66% for controls). There was no difference in intervention vs control group respectively in terms of average number of hours CPAP used-on all days (2.86 vs 2.88 p=0.27), average number of hours CPAP used-on nights used(3.45 vs 3.44 p=0.22) and percentage of days with usage more than 4 hours(32 vs 35 p=0.33) Around 1/3 patients in both-groups reported CPAP-use for ≥ 4 hours/night for at least 70% of nights (32% versus 35% controls, p=0.33) indicating similar acceptable adherence. Both groups demonstrated a significant reduction in their ESS post-intervention.
CONCLUSIONS: CPAP mask acclimatization at home did not increase CPAP adherence in our study cohort. Despite adequate adherence in only one third of the total participants, a significant decline in excessive daytime sleepiness was seen.
CLINICAL IMPLICATIONS: There is need for greater educational intervention to improve adherence to home CPAP therapy to reduce debilitating consequences of OSA.
DISCLOSURE: The following authors have nothing to disclose: Sandeep Gupta, Nagabhushanam Bollavaram, Shawn Knapik
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