Objective measurement of patterns of nasal CPAP use by patients with obstructive sleep apnea.

Obstruction of the upper airway during sleep (OSAS) is widely treated by having patients self-administer nasal continuous positive airway pressure (CPAP). To obtain objective evidence of the patterns of CPAP use, information was gathered from two urban sites on 35 OSAS patients who were prescribed CPAP for a total of 3,743 days. Patients were given CPAP machines that contained a microprocessor and monitor that measured actual pressure at the mask for every minute of each 24-h day for an average of 106 days per patient. They were not aware of the monitor inside the CPAP machines. Monitor output was compared with patients' diagnostic status, pretreatment clinical and demographic characteristics, and follow-up self-reports of CPAP use, problems, side effects, and aspects of daytime fatigue and sleepiness. Patients attempted to use CPAP an average of 66 +/- 37% of the days monitored. When CPAP was used, the mean duration of use was 4.88 +/- 1.97 h. However, patients' reports of the duration of CPAP use overestimated actual use by 69 +/- 110 min (p < 0.002). Both frequency and duration of CPAP use in the first month reliably predicted use in the third month (p < 0.0001). Although the majority (60%) of patients claimed to use CPAP nightly, only 16 of 35 (46%) met criteria for regular use, defined by at least 4 h of CPAP administered on 70% of the days monitored. Relative to less regular users, these 16 patients had more years of education (p = 0.05), and were more likely to work in professional occupations.(ABSTRACT TRUNCATED AT 250 WORDS)

[1]  N. Saunders,et al.  Long-term acceptance of continuous positive airway pressure in obstructive sleep apnea. , 1991, The American review of respiratory disease.

[2]  A. Pack,et al.  Clinical significance of sleep apnea in the elderly. , 1987, The American review of respiratory disease.

[3]  G. S. Tune.  Sleep and wakefulness in 509 normal human adults. , 1969, The British journal of medical psychology.

[4]  ColinE. Sullivan,et al.  REVERSAL OF OBSTRUCTIVE SLEEP APNOEA BY CONTINUOUS POSITIVE AIRWAY PRESSURE APPLIED THROUGH THE NARES , 1981, The Lancet.

[5]  P. L. Smith,et al.  Upper airway pressure-flow relationships in obstructive sleep apnea. , 1988, Journal of applied physiology.

[6]  J. Krieger,et al.  Objective measurement of compliance with nasal CPAP treatment for obstructive sleep apnoea syndrome. , 1988, The European respiratory journal.

[7]  E. Fletcher,et al.  The effect of positive reinforcement on hourly compliance in nasal continuous positive airway pressure users with obstructive sleep apnea. , 1991, The American review of respiratory disease.

[8]  R. Rogers,et al.  Patient compliance with nasal CPAP therapy for sleep apnea. , 1986, Chest.

[9]  T Wanke,et al.  Acceptance of CPAP therapy for sleep apnea. , 1991, Chest.

[10]  EEG of human sleep: R.M. Williams, I. Karacan and C. Hursch. (John Wiley and Sons Ltd., Chichester, Sussex, 1974, 169 p., ill., £8.20). , 1976 .

[11]  C. Pollak,et al.  Nocturnal nasal-airway pressure for sleep apnea. , 1983, The New England journal of medicine.

[12]  P. L. Smith,et al.  The effects of protriptyline in sleep-disordered breathing. , 1983, The American review of respiratory disease.

[13]  V. Anand,et al.  Obstructive Sleep Apnea: A Comparison of Continuous Positive Airway Pressure and Surgical Treatment , 1991, Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery.

[14]  A. O'donnell,et al.  Long-term compliance with nasal continuous positive airway pressure therapy of obstructive sleep apnea. , 1990, Chest.

[15]  J. Conway,et al.  Treatment of obstructive sleep apnea with nasal continuous positive airway pressure. Patient compliance, perception of benefits, and side effects. , 1992, The American review of respiratory disease.

[16]  P. Schweitzer,et al.  Management of obstructive sleep apnea: Comparison of various treatment modalities , 1988, The Laryngoscope.

[17]  K. Rajagopal,et al.  Overnight nasal CPAP improves hypersomnolence in sleep apnea. , 1986, Chest.

[18]  J. Horne.  Why we sleep , 1988 .

[19]  E. Sforza,et al.  Long-term effects of treatment with nasal continuous positive airway pressure on daytime lung function and pulmonary hemodynamics in patients with obstructive sleep apnea. , 1990, The American review of respiratory disease.

[20]  C. Sullivan,et al.  Home treatment of obstructive sleep apnoea with continuous positive airway pressure applied through a nose-mask. , 1984, Bulletin europeen de physiopathologie respiratoire.

[21]  C. Rand,et al.  A nebulizer chronolog to monitor compliance with inhaler use. , 1991, The American journal of medicine.

[22]  C. Guilleminault,et al.  Compliance and side effects in sleep apnea patients treated with nasal continuous positive airway pressure. , 1989, The Western journal of medicine.

[23]  C. Sullivan,et al.  The immediate effects of nasal continuous positive airway pressure treatment on sleep pattern in patients with obstructive sleep apnea syndrome. , 1986, Electroencephalography and clinical neurophysiology.