PURPOSE:Poor compliance and initial intolerance limit the effectiveness of CPAP in OSA. Short-term compliance often predicts long-term use. Unfortunately, few variables have been identified that predict initial CPAP tolerance and short-term compliance. We sought to identify potential variables at the time of polysomnography that would predict short-term CPAP use.
METHODS:Retrospective review of consecutive patients during follow-up (4–6 weeks) after beginning CPAP therapy. All patients initiated therapy following an attended, overnight CPAP titration. Measured variables included demographic data, degree of sleepiness, type of study, AHI, polysomnographic quality, REM and slow-wave sleep on CPAP, and use of a non-benzodiazepine sedative-hypnotic during polysomnography. Compliance was verified using smart-card compliance data. Data were compared between those with good versus poor compliance, which we defined as usage for >4 hours/night more than 70% of nights. We also compared the highest versus lowest quartile of CPAP usage. Each variable was analyzed as an independent predictor of compliance.
RESULTS:We included 400 consecutive patients (78% male, mean age 47±8 years). Of the measured variables, only age (48±8 v 46±7 years, p=0.01) and use of sedative-hypnotics during CPAP titration polysomnography (81% v 68%, p=0.02), were associated with better compliance. No other variable predicted short-term compliance. Those who received sedative-hypnotics for their polysomnography experienced longer sleep times (345±41 vs. 312±53 minutes, p<0.001) and greater sleep efficiencies (84±9% v 79±11%, p=0.002). CPAP titrations were improved in those receiving sedative-hypnotics during polysomnography, achieving lower AHIs on final CPAP pressure (6±7 v 13±16, p=0.001).
CONCLUSION:The use of sedative-hypnotics during polysomnography was the only variable associated with improved short-term compliance. A one-time use of sedative-hypnotics during initial CPAP titration facilitated better polysomnographic data and CPAP titrations, which, in turn lead to greater use of CPAP in the initial 4–6 weeks of CPAP therapy. Improved initial CPAP tolerance and usage should improve long-term compliance.
CLINICAL IMPLICATIONS:Sedative-hypnotic administration during polysomnography may improve short-term CPAP compliance.
DISCLOSURE:Jacob Collen, No Financial Disclosure Information; No Product/Research Disclosure Information