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Effect of Psychiatric Diagnoses and Medications on CPAP Adherence in VA Patients FREE TO VIEW

Pablo E. Molina, MD*; Paul Ingmundson, PhD; Laura E. Lajos, PhD; Stephen S. Im, MD
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University of Texas Health Science Center at San Antonio, San Antonio, TX


Chest


Chest. 2004;126(4_MeetingAbstracts):781S. doi:10.1378/chest.126.4_MeetingAbstracts.781S
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Abstract

PURPOSE:  Continuous positive airway pressure (CPAP) adherence is the key element for a successful outcome in patients with obstructive sleep apnea (OSA). CPAP therapy has been associated with decreased incidence of cardiovascular disease and improvement in quality of life. Despite the benefits of CPAP therapy, CPAP non-adherence is commonly seen in sleep centers. We studied the effect of psychiatric diagnoses and medications on CPAP adherence, in patients from a large VA hospital in San Antonio.

METHODS:  Objective CPAP adherence was evaluated using the Encore/Smart card reader software. Adherence was defined as a usage of CPAP for 4 or more hours per night. Non-adherence was defined as <4 hours of CPAP usage per night. A total of 80 patients were enrolled in the study after informed consent was obtained. Psychiatric diagnoses, medications usage, and demographics, were obtained through questionnaires and review of the clinical records. All analysis was performed with the Statistical Analysis Software (SAS) version 8.2.

RESULTS:  Of the 80 patients enrolled, 43 (53.7%) were adherent to CPAP, and 37 (46.3%) were non-adherent to CPAP. Adherence data were measured in each patient for an average of 313.1 days (10-1129 days). The results and demographics are presented in table 1VariablesCPAPAdherence (n=43)CPAPNonadherance (n=37)P valueAge4.3 +-8.558.4 +-11.40.07Male gender40 (93%)34 (91.9%)1Female gender3 (7%)3 (8.1%)White ethnicity18 (41.9)15 (40.5)0.54AfricanAmerican ethnicity8 (18.6)4 (10.8)Hispanic17 (39.5)18 (48.7)Severity: Mild OSA5 (11.6)6 (16.2)0.22Moderate OSA14 (32.6)13 (35.1)Severe OSA24 (55.8)15 (40.5)UARS0 (0.0)3 (8.1)# of psyche dx: None20 (46.5)15 (40.5)0.96One13 (30.2)12 (32.5)Two7 (16.3)7 (18.9)Three3 (7.0)3 (8.1)Psych Dx: None20 (46.5)15 (40.5)0.59Depression20 (46.5)16 (43.2)0.77PTSD8 (18.6)13 (35.1)0.09Schizophrenia1 (2.3)1 (2.7)1Bipolar disorder1(2.3)1 (2.7)1Anxiety disorder4 (9.3)5 (13.5)0.73Social Phobia1 (2.3)0 (0.0)1Defiant personality disorder1 (2.3)0 (0.0)1# of psyche Meds: None22 (51.2)15 (40.5)0.46One12 (27.9)7 (18.9)Two4 (9.3)9 (24.3)Three3 (7.0)3 (8.1)Four1 (2.3)2 (5.4)Five1 (2.3)1 (2.7)Medication: none22 (51.2)16 (43.2)0.48Benzodiazepines5 (11.6)9 (24.3)0.14SSRI12 (27.9)15 (40.5)0.23TCA0 (0.0)6 (16.2)0.007Antipsychotics3 (7.0)1 (2.7)0.62Bupropion3 (7,0)4 (10.8)0.7Venlafaxine2 (4.7)1 (2.7)1Nefazodone2 (4.7)0 (0.0)0.5Anticonvulsant1 (2.3)0 (0.0)1Buspirone1 (2.3)2 (5.4)0.59Hydroxizine1 (2.3)2 (5.4)0.59Trazodone3 (7.0)5 (13.5)0.46Mirtazapine2 (4.7)0 (0.0)0.5MASK: Respironic profile lite32 (74.4)25 (67.6)0.83Nasal pillow7 (16.3)7 (18.9)Full face mask1 (2.3)2 (5.4)Serenity nasal mask1 (2.3)0 (0.0)Ultramirage nasal mask2 (4.7)3 (8.1). There was no significant difference between CPAP adherent and CPAP non-adherent groups for each variable, except for patients taking tricyclic antidepressants, who were more likely to be non-adherent (p-value < .01).

CONCLUSION:  Psychiatric diagnoses, medications, ethnicity, CPAP mask, and severity of the OSA, have no impact on CPAP adherence in patients with obstructive sleep apnea.

CLINICAL IMPLICATIONS:  Psychiatric disorders and medications seem not to have an impact on CPAP adherence in patients with OSA. Thus, in non-adherent patients, careful assessment of other factors must be evaluated, in order to improve adherence.

DISCLOSURE:  P.E. Molina, None.

Wednesday, October 27, 2004

10:30 AM- 12:00 PM


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