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Original Research: SLEEP MEDICINE |

Clinical and Polysomnographic Predictors of Short-Term Continuous Positive Airway Pressure Compliance

Jacob Collen, MD; Christopher Lettieri, MD, FCCP; William Kelly, MD, FCCP; Stuart Roop, MD, FCCP
Author and Funding Information

*From the Department of Internal Medicine (Dr. Collen), Walter Reed Army Medical Center, Washington, DC; and Uniformed Services University of the Health Sciences (Drs. Lettieri, Kelly, and Roop), Bethesda, MD.

Correspondence to: Jacob Collen, MD, 1375 Kenyon Street NW, Apt 220, Washington, DC 20010; e-mail: jacob.collen@us.army.mil


The views expressed in this article are those of the authors and do not reflect the official policy of the Department of the Army, Department of Defense, or the US Government.

Dr. Collen has no conflicts of interest to disclose. Dr. Lettieri has conducted research using unrestricted grants provided by Sepracor Inc to the Henry M. Jackson Foundation for the Advancement of Military Medicine. Dr. Kelly has no conflicts of interest to disclose. Dr. Roop has no conflicts of interest to disclose.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).


Chest. 2009;135(3):704-709. doi:10.1378/chest.08-2182
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Background:  Poor compliance and initial intolerance limit the effectiveness of continuous positive airway pressure (CPAP) in obstructive sleep apnea. Short-term compliance has been shown to predict long-term use. Unfortunately, few identified variables reliably predict initial CPAP tolerance and use. We sought to identify potential pretreatment variables that would predict short-term use of CPAP.

Methods:  We performed a retrospective review assessing short-term CPAP compliance after 4 to 6 weeks of treatment. Consecutive patients initiating CPAP therapy were included. Demographic and polysomnographic variables were correlated with objective measures of CPAP use. The average hours per night and percentage of nights of CPAP use were correlated with each variable. Variables were also associated with good vs poor compliance, which we defined as > 4 h per night > 70% of nights.

Results:  We included 400 consecutive patients (78% male; mean age, 47 ± 8 years). Of the measured variables, only age (48 ± 8 years vs 46 ± 7 years, p = 0.02) and use of a sedative/hypnotic during CPAP titration (77% vs 57.6%, p < 0.0005) were associated with better compliance. Those receiving a sedative/hypnotic had longer sleep times (345 ± 42 min vs 314 ± 51 min, p < 0.0005) and greater sleep efficiency (84 ± 9% vs 78 ± 11%, p < 0.0005) during polysomnography. CPAP titrations were improved in those receiving sedative/hypnotics, achieving lower respiratory disturbance index on the final CPAP pressure (6 ± 7 vs 10 ± 11, p = 0.04).

Conclusions:  Of the measured variables, only age and a one-time use of sedative/hypnotics during polysomnography correlated with greater short-term CPAP compliance. Hypnotics facilitated better quality CPAP titrations. Reliable predictors of short-term CPAP use could help identify measures to improve long-term compliance.


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