Treatment of Obstructive Sleep Apnea with Nasal Continuous Positive Airway Pressure (CPAP)

Patient Compliance, Perception of Benefits, and Side Effects

The following information is provided by: Fisher & Paykel Healthcare

By Dr. Vanessa MB Jordan Ph.D., Research Scientist, Fisher & Paykel Healthcare

V. Hoffstein, S. Viner, S. Mateika and J. Conway
Am Rev Respir Dis 1992; 145(4): 841-845

Key Points

• This study showed that when patients are questioned about the amount of time they use CPAP, they report very high levels of compliance (compliance levels were not confirmed by covert monitoring-see study by Kribbs).
• Patients were more likely to continue treatment if they perceived they were receiving benefit from it.
• Patients were more likely to return their CPAP machine if their family and friends did not perceive any change in their behavior.
• There were no differences in the nature or incidence of side effects between those who ceased treatment and those who continued to use CPAP.
• One of the most commonly reported side effects related to discomfort of the nose and/or throat.

Aim

To examine the compliance of patients with sleep apnea who had been started on home CPAP.
To compare the compliance of CPAP in Ontario with that reported in other patient populations.

Method

Retrospectively reviewed files of patients who had been started on nasal CPAP.

Mailed out a questionnaire to 148 patients (96 replied) who had been diagnosed with obstructive sleep apnea (OSA).

Questionnaire comprised of eight simple questions. Answers were used to assess differences between patients who continued to use CPAP comparative to those who had returned their machines.

Results

Of the 96 patients who replied to the questionnaire 17 had returned the equipment. Therefore 82% had kept the equipment. Of the 52 patients who did not reply, 10 could not be contacted and of the remainder 16 had returned their CPAP machines. So at worst of the 148 patients 105 (71%) had retained their machines.

Those who kept their CPAP machines were significantly more obese and had a higher hourly usage of the machines than those who returned them.

Patients were more likely to return the CPAP machine if they felt they were gaining no benefit from the treatment and if their family and friends had noticed no change in their behavior.

Most common side effects were waking up during the night and side effects relating to nose and throat.

There were no significant differences in the incidence or nature of the side effects experienced by those who returned the CPAP equipment comparative to those who had retained it.

Only 10% of compliant patients had adverse comments about the CPAP equipment versus 59% of the non-compliant patients.

Conclusions

This study demonstrates that although many patients report adverse side effects of CPAP, the compliance with this treatment is relatively high. And a large majority of patients perceive the treatment as beneficial.

When the compliance levels measured in this study were compared to those reported previously it was shown that the cost free access to equipment in Ontario did not increase compliance comparative to that seen in areas where there is cost involved in the use of CPAP.