Sleep Disorders |

Evaluation of a Continuous Positive Airway Pressure Desensitization Protocol for CPAP-Intolerant Patients: A Pilot Study FREE TO VIEW

Patricia Dettenmeier, MSN; Enrique Ordaz, MD; Joseph Espiritu, MD
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Saint Louis University, St. Louis, MO

Chest. 2013;144(4_MeetingAbstracts):979A. doi:10.1378/chest.1700938
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SESSION TYPE: Original Investigation Slide

PRESENTED ON: Sunday, October 27, 2013 at 03:00 PM - 04:00 PM

PURPOSE: Only 1 case report has been published on the efficacy of CPAP desensitization in managing claustrophobia in a patient with obstructive sleep apnea (OSA) and CPAP intolerance. The study aims to determine whether CPAP adherence (percentage of days used and average time used per night) increases after CPAP desensitization therapy in OSA patients with CPAP intolerance.

METHODS: This retrospective cohort study evaluated efficacy of CPAP desensitization therapy on CPAP adherence in CPAP-intolerant OSA patients. The CPAP desensitization protocol was implemented by a nurse practitioner and consisted of a thorough evaluation of past CPAP use, masks used, problems encountered, and solutions tried previously. Interventions were multifaceted: changing the mask, changing the machine to auto-titrate, progressive daytime CPAP trial, etc.

RESULTS: There were no meaningful significant differences in age, BMI, neck circumference, Epworth Sleepiness and Fatigue Severity scores, diagnostic and therapeutic PSG parameters between the CPAP adherent and the non-adherent groups. There was no difference in CPAP use based on gender, race, type of PSG (split vs. full-night), or optimal CPAP determined. Using Repeated Measures ANOVA with post-hoc comparisons, there was a significant difference in average minutes of CPAP use between baseline (9.5±31.1 min) and day 30 (100.4±151.3 min, p=.018), but not at day 90 (69.1±30.2 min, p=.99). However, there was a significant improvement in %days with CPAP use > 4 hours baseline (0.3%) vs. day 30 (22.1%, p=.009) and day 90 (15.7%, p=0.45), respectively. Only 2/22 patients used any CPAP at baseline. Ninety days post-desensitization, 4/22 patients were adherent using CPAP ≥4 hours for ≥70% of the days. The CPAP adherent (vs. non-adherent) group had a significantly higher CPAP use at 30 days (339.5 vs. 47.22 min, p<.001) and 90 days (361.75 vs. 4.33 min, p<.001).

CONCLUSIONS: CPAP desensitization modestly improves CPAP adherence in selected CPAP intolerant OSA patients.

CLINICAL IMPLICATIONS: This study supports CPAP desensitization as therapy for CPAP non-adherence due to claustrophobia or mask intolerance. A larger prospective study is needed to validate our findings.

DISCLOSURE: The following authors have nothing to disclose: Patricia Dettenmeier, Enrique Ordaz, Joseph Espiritu

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