Objective: To identify potential risk factors for the
need for an additional cold or heated humidifier in nasal continuous
positive airway pressure (nCPAP) circuitry.
prospective cohort study.
Setting: University hospital
consecutive patients with obstructive sleep apnea syndrome were
followed up for a median of 347 days (range, 3 to 530 days) after the
initiation of nCPAP therapy.
Measurements and results:
In 46 patients (56%), the occurrence of upper-airway symptoms led to
the addition of a cold humidifier after a median time of 39 days
(range, 2 to 94 days). In 23 of the 46 patients, the persistence of the
symptoms indicated the secondary use of a heated humidifier after a
median time of 28 days (range, 5 to 70 days). nCPAP use
(mean ± SD) was not influenced by cold humidification
(4.58 ± 2.05 h/d vs 4.7 ± 2.48 h/d; p = 0.75), but it increased
significantly with heated humidification (5.38 ± 2.26 h/d vs
3.51 ± 2.53 h/d; p < 0.01). Anthropometric characteristics,
drying medications, clinical findings such as deformity of the nasal
septum, symptoms of a chronic mucosa disease (CMD), a previous
uvulopalatopharyngoplasty (UPPP), and polysomnographic parameters had
no significant effect on the need for a cold humidifier. Age > 60
years (odds ratio [OR], 5.58; 95% confidence interval [CI], 1.69
to 18.43), drying medications (OR, 6.59; 95% CI, 1.29 to 33.51),
presence of CMD (OR, 4.11; 95% CI, 1.24 to 13.58), and previous UPPP
(OR, 4.56; 95% CI, 1.18 to 17.6) were found as significant risk
factors for the addition of a heated humidifier.
Conclusion: Our results demonstrate that heated
humidification significantly improves the nCPAP daily rate of use and
that its need may be predicted.