The initial experience with CPAP may predict subsequent compliance. In a retrospective review, we found that premedication with non-benzodiazepine sedative-hypnotics during CPAP titration polysomnography independently predicted short-term compliance. To validate these findings, we conducted a prospective clinical trial to assess whether premedication with eszopiclone prior to CPAP titration would improve short-term CPAP compliance.
Prospective, randomized, double-blinded, placebo-controlled trial. Subjects received eszopiclone 3 mg or matching placebo prior to their CPAP titration polysomnography. We compared the quality of CPAP titrations and objective measures of compliance during the first 4–6 weeks of therapy between the two groups.
We enrolled 117 subjects and 98 completed the protocol (50 eszopiclone and 48 placebo). There were more women in the eszopiclone group, otherwise, groups were similar at baseline. Premedication with eszopiclone significantly improved sleep efficiency (87.8%±5.8% vs. 80.1%±10.5%; p=0.002) and total sleep time (350.9±33.6 minutes vs. 319.7±48.7 minutes; p=0.007). There was a trend towards improved sleep latency (19.4±16.1 minutes vs. 31.8±30.4 minutes; p=0.08) and residual obstructive events on the final CPAP pressure (6.4±7 events/hr vs. 12.8±14.6 events/hr; p=0.08) during polysomnography. Eszopiclone significantly improved CPAP compliance. Among those pre-medicated with eszopiclone, CPAP was used on more nights (75.9%±20.0% vs. 60.1%±24.3%; p=0.005) and for more hours per night (4.8±1.5 v 3.9±1.8; p=0.03).
Premedication with eszopiclone on the night of CPAP titration improved the quality of CPAP titration and led to significantly greater short-term compliance.
We recommend the use of eszopiclone during CPAP titration to improve titration quality and short-term CPAP compliance.
Jacob Collen, No Financial Disclosure Information; No Product/Research Disclosure Information