Advertisement

Sleep and Vigilance

, Volume 3, Issue 2, pp 113–118 | Cite as

CPAP Compliance in Obstructive Sleep Apnea

  • Manvir BhatiaEmail author
  • Yogendra Singh
Review
  • 335 Downloads

Abstract

OSA is a common sleep-related breathing disorder, characterized by frequent interruptions of breathing during sleep and leading public health problem both in the developed and developing nations. However, awareness regarding diagnostic options, management, and consequences of untreated OSA remains inadequate. In developing nations, the resources for adequate sleep medicine facilities are scarce. Therefore, there is a need for low cost, simple and accurate diagnostic and therapeutic modalities. The most effective treatment for patients with significant OSA has been a CPAP device which delivers positive air pressure to the airway. Despite the efficacy of CPAP for the treatment of OSA, compliance with therapy remains suboptimal. This acts as a physiological splint, thus preventing collapse of the upper airway. Compliance rates were 30−80% from different parts of the globe. The adverse effects of untreated OSA were well documented and have been shown to be reversible with therapy. Therefore, an increase in CPAP compliance is considered clinically relevant. It is important that adherence to CPAP therapy continues to be improved. Increase CPAP compliance is essential thus it is important that adherence to CPAP therapy is enforced. Measures for good CPAP compliance are patient education, a good doctor−patient relationship, role of partner/family, and an intensive follow-up program, which can be addressed through a multidisciplinary team approach.

Keywords

CPAP compliance OSA: obstructive sleep apnea 

Notes

Acknowledgements

The authors wish to thank Geeta Yadav, Mahi Yadav, and the staff of Neurology Sleep Centre for their help.

Funding

There are no funding sources to report for this manuscript.

Compliance with Ethical Standards

Conflict of interest

The authors report no conflicts of interest.

Ethical Approval

This article does not contain any studies with human participants or animals performed by any of the authors.

References

  1. 1.
    Hussain SF, Cloonan YK, Islam M, Rahbar MH. Prevalence and associated risk factors of sleep-disordered breathing symptoms in young and middle-aged Pakistani employed adults. Sleep Breath. 2010;14:137–44.PubMedCrossRefGoogle Scholar
  2. 2.
    Epstein LJ, Kristo D, Strollo PJ Jr, Friedman N, Malhotra A, Patil SP, et al. Adult Obstructive Sleep Apnea Task Force of the American Academy of Sleep Medicine. Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med. 2009;5:263–76.PubMedGoogle Scholar
  3. 3.
    Howard ME, Desai AV, Grunstein RR, Hukins C, Armstrong JG, Joffe D. Sleepiness, sleep-disordered breathing, and accident risk factors in commercial vehicle drivers. Am J Respir Crit Care Med. 2004;170:1014–21.PubMedCrossRefGoogle Scholar
  4. 4.
    Giles TL, Lasserson TJ, Smith BH, White J, Wright J, Cates CJ. Continuous positive airways pressure for obstructive sleep apnoea in adults. Cochrane Database Syst Rev. 2006;3:CD001106.Google Scholar
  5. 5.
    Sharma SK, Kumpawat S, Banga A, Goel A. Prevalence and risk factors of obstructive sleep apnoea syndrome in a population of Delhi, India. Chest. 2006;130:149–56.PubMedCrossRefGoogle Scholar
  6. 6.
    Reddy EV, Kadhivaran T, Mishra HK, Sreenivas V, Handa KK, Sinha S, et al. Prevalence and risk factors of obstructive sleep apnoea among middle-aged urban Indians: a community based study. Sleep Med. 2009;10:913–8.PubMedCrossRefGoogle Scholar
  7. 7.
    Vijayan VK, Patial K. Prevalence of obstructive sleep apnoea syndrome in Delhi, India. Chest. 2006;130:92S.CrossRefGoogle Scholar
  8. 8.
    Sin DD, Mayers I, Man GC, Pawluk L. Long-term compliance rates to continuous positive airway pressure in obstructive sleep apnea: a population-based study. Chest. 2002;121:430–5.PubMedCrossRefGoogle Scholar
  9. 9.
    Sopkova Z, Dorkova Z, Tkacova R. Predictors of compliance with continuous positive airway pressure treatment in patients with obstructive sleep apnea and metabolic syndrome. Wien Klin Wochenschr. 2009;121:398–404.PubMedCrossRefGoogle Scholar
  10. 10.
    Weaver TE, Grunstein RR. Adherence to continuous positive airway pressure therapy: the challenge to effective treatment. Proc Am Thorac Soc. 2008;5:173–8.PubMedPubMedCentralCrossRefGoogle Scholar
  11. 11.
    Zozula R, Rosen R. Compliance with continuous positive airway pressure therapy: assessing and improving treatment outcomes. Curr Opin Pulm Med. 2001;7:391–8.PubMedCrossRefGoogle Scholar
  12. 12.
    Berkani K, Dimet J, Breton P, Bizieux-Thaminy A, Berruchon J. Management of the sleep apnoea syndrome in a general hospital. J Rev Mal Respir. 2012;29:871–7.CrossRefGoogle Scholar
  13. 13.
    Goyal Abhishek, Pakhare Namrata Agarwal Abhijit. Barriers to CPAP use in India: an exploratory study. J Clin Sleep Med. 2017;13(12):1385–94.PubMedPubMedCentralCrossRefGoogle Scholar
  14. 14.
    American Academy of Sleep Medicine. Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. The Report of an American Academy of Sleep Medicine Task Force. Sleep.1999; 22: 667−89.Google Scholar
  15. 15.
    Wang Y, Gao W, Sun M, Chen B. Adherence to CPAP in patients with obstructive sleep apnea in a Chinese population. Respir Care. 2012;57(2):238–43.PubMedGoogle Scholar
  16. 16.
    Hui DS, Ko FW, Chan JK, To KW, Fok JP, Ngai JC, Chan MC, Tung A, Chan DP, Ho CW, Lai CK. Sleep-disordered breathing and continuous positive airway pressure compliance in a group of commercial bus drivers in Hong Kong. Respirology. 2006;11(6):723–30.PubMedCrossRefGoogle Scholar
  17. 17.
    Billings ME, Auckley D, Benca R, Foldvary-Schaefer N, Iber C, Redline S, Rosen CL, Zee P, Kapur VK. Race and residential socioeconomics as predictors of CPAP adherence. Sleep. 2011;34(12):1653–8.PubMedPubMedCentralCrossRefGoogle Scholar
  18. 18.
    Bakker JP, O’Keeffe KM, Neill AM, Campbell AJ. Ethnic disparities in CPAP adherence in New Zealand: effects of socioeconomic status, health literacy and self-efficacy. Sleep. 2011;34(11):1595–603.PubMedPubMedCentralCrossRefGoogle Scholar
  19. 19.
    McArdle N, Devereux G, Heidarnejad H, Engleman HM, Mackay TW, Douglas NJ. Long-term use of CPAP therapy for sleep apnea/hypopnea syndrome. Am J Respir Crit Care Med. 1999;159:1108–14.PubMedCrossRefGoogle Scholar
  20. 20.
    Hollandt JH, Mahlerwein M. Nasal breathing and continuous positive airway pressure in patients with obstructive sleep apnea (OSA). Sleep Breath. 2003;7(2):87–94.PubMedCrossRefGoogle Scholar
  21. 21.
    Sawyer AM, Gooneratne NS, Marcus CL, Ofer D, Richards KC, Weaver TE. A systematic review of CPAP adherence across age groups: clinical and empiric insights for developing CPAP adherence interventions. Sleep Med Rev. 2011;15:343.PubMedPubMedCentralCrossRefGoogle Scholar
  22. 22.
    Zonato AI, Bittencourt LR, Martinho FL, Baiard P, Togeiro SM, Benedito-Silva AA, et al. A comparison of public and private obstructive sleep apnea clinics. Braz J Med Biol Res. 2004;37:69–76.PubMedCrossRefGoogle Scholar
  23. 23.
    Mathew N, Balachandran J. CPAP compliance in patients with moderate to severe obstructive sleep apnea from three centers in South India. Int J Res Med Sci. 2017;5(11):4886–90.CrossRefGoogle Scholar
  24. 24.
    Chasens ER, Pack AI, Maislin G, Dinges DF, Weaver TE. Claustrophobia and adherence to CPAP treatment. West J Nurs Res. 2005;27(3):307–21.PubMedCrossRefGoogle Scholar
  25. 25.
    Johnston M, Jonshton DW, Wilkes H, Burns LE, Thorpe GL. Cumulative scales for the measurement of agoraphobia. Br J Clin Psychol. 1984;23:133–43.PubMedCrossRefGoogle Scholar
  26. 26.
    Krakow B, Ulibarri V, Melendrez D, Kikta S, Togami L, Haynes P. A daytime, abbreviated cardio-respiratory sleep study (CPT 95807-52) to acclimate insomnia patients with sleep disordered breathing to positive airway pressure (PAP-NAP). J Clin Sleep Med. 2008;4(3):212–22.PubMedPubMedCentralGoogle Scholar
  27. 27.
    American Association of Sleep Technologists. AAST technical guideline for positive airway pressure (PAP) adherence and follow-up care. A2ZZZ. 2009;18(2):16.Google Scholar
  28. 28.
    Aloia MS, Di Dio L, Ilniczky N, Perlis ML, Greenblatt DW, Giles DE. Improving compliance with nasal CPAP and vigilance in older adults with OAHS. Sleep Breath. 2001;5(1):13–21.PubMedCrossRefGoogle Scholar
  29. 29.
    Sawyer AM, Gooneratne NS, Marcus CL, Ofer D, Richards KC, Weaver TE. A systematic review of CPAP adherence across age groups: clinical and empiric insights for developing CPAP adherence interventions. Sleep Med Rev. 2011;15:343–56.PubMedPubMedCentralCrossRefGoogle Scholar
  30. 30.
    Shahar E, Whitney CW, Redline S, et al. Sleep disordered breathing and cardiovascular disease: cross-sectional results of the Sleep Heart Health Study. Am J Respir Crit Care Med. 2001;163:19–25.PubMedCrossRefGoogle Scholar
  31. 31.
    Haentjens P, Van Meerhaeghe A, Moscariello A, et al. The impact of continuous positive airway pressure on blood pressure in patients with obstructive sleep apnoea syndrome: evidence from a meta-analysis of placebo-controlled randomized trials. Arch Intern Med. 2007;167:757–64.PubMedCrossRefGoogle Scholar
  32. 32.
    Kjelsberg FN, Ruud EA, Stavem K. Predictors of symptoms of anxiety and depression in obstructive sleep apnea. Sleep Med. 2005;6(4):341–6.PubMedCrossRefGoogle Scholar
  33. 33.
    Lewis KE, Seale L, Bartle IE, Watkins AJ, Ebden P. Early predictors of CPAP use for the treatment of obstructive sleep apnea. Sleep. 2004;27:134–8.PubMedCrossRefGoogle Scholar
  34. 34.
    Janson C, Noges E, Svedberg-Randt S, Lindberg E. What characterizes patients who are unable to tolerate continuous positive airway pressure treatment. Respir Med. 2000;94:145–9.PubMedCrossRefGoogle Scholar
  35. 35.
    Norman D, Loredo JS, Nelesen RA, Ancoli-Israel S, Mills PJ, Ziegler MG, et al. Effects of continuous positive airway pressure versus supplemental oxygen on 24-hour ambulatory blood pressure. Hypertension. 2006;47:840–5.PubMedCrossRefGoogle Scholar
  36. 36.
    Goyal Abhishek, Pakhare Namrata Agarwal Abhijit. Barriers to CPAP use in India: an exploratory study. J Clin Sleep Med. 2017;13(12):1385–94.PubMedPubMedCentralCrossRefGoogle Scholar
  37. 37.
    Simon-Tuval T, Reuveni H, Greenberg-Dotan S, Oksenberg A, Tal A, Tarasiuk A. Low socioeconomic status is a risk factor for CPAP acceptance among adult OSAS patients requiring treatment. Sleep. 2009;32(4):545–52.PubMedPubMedCentralCrossRefGoogle Scholar
  38. 38.
    Dzierzewski JM, Wallace DM, Wohlgemuth WK. Adherence to continuous positive airway pressure in existing users: self-efficacy enhances the association between continuous positive airway pressure and adherence. J Clin Sleep Med. 2016;12(2):169–76.PubMedPubMedCentralCrossRefGoogle Scholar
  39. 39.
    Weaver TE, Sawyer AM. Adherence to continuous positive airway pressure treatment for obstructive sleep apnoea: implications for future interventions. Indian J Med Res. 2010;131:245–58.PubMedPubMedCentralGoogle Scholar
  40. 40.
    Kribbs NB, Pack AI, Kline LR, et al. Effects of one night without nasal CPAP treatment on sleep and sleepiness in patients with obstructive sleep apnoea. Am Rev Respir Dis. 1993;147:1162–8.PubMedCrossRefGoogle Scholar
  41. 41.
    Kohler M, Stoewhas AC, Ayers L, et al. Effects of continuous positive airway pressure therapy withdrawal in patients with obstructive sleep apnoea: a randomized controlled trial. Am J Respir Crit Care Med. 2011;184:1192–9.PubMedCrossRefGoogle Scholar
  42. 42.
    Rossi VA, Stoewhas AC, Camen G, et al. The effects of continuous positive airway pressure therapy withdrawal on cardiac repolarization: data from a randomized controlled trial. Eur Heart J. 2012;33:2206–12.PubMedCrossRefGoogle Scholar
  43. 43.
    Guest JF, Helter MT, Morga A, Stradling JR. Cost effectiveness of using continuous positive airway pressure in the treatment of severe obstructive sleep apnoea/hypopnoea syndrome in the UK. Thorax. 2008;63:860–5.PubMedCrossRefGoogle Scholar
  44. 44.
    Kapur V, Blough DK, Sandblom RE, et al. The medical cost of undiagnosed sleep apnoea. Sleep. 1999;22:749–55.PubMedCrossRefGoogle Scholar
  45. 45.
    Wittmann V, Rodenstein DO. Health care costs and the sleep apnoea syndrome. Sleep Med Rev. 2004;8:269–79.PubMedCrossRefGoogle Scholar
  46. 46.
    Barbe F, Duran-Cantolla J, Sanchez-de-la-Torre M, et al. Effect of continuous positive airway pressure on the incidence of hypertension and cardiovascular events in non-sleepy patients with obstructive sleep apnoea: a randomized controlled trial. JAMA. 2012;307:2161–8.PubMedCrossRefGoogle Scholar
  47. 47.
    Montesi SB, Edwards BA, Malhotra A, Bakker JP. The effect of continuous positive airway pressure treatment on blood pressure: a systematic review and meta-analysis of randomized controlled trials. J Clin Sleep Med: JCSM: Off Publ of the Am Acad of Sleep Med. 2012;8:587–96.Google Scholar
  48. 48.
    Marin JM, Agusti A, Villar I, et al. Association between treated and untreated obstructive sleep apnoea and risk of hypertension. JAMA. 2012;307:2169–76.PubMedPubMedCentralCrossRefGoogle Scholar
  49. 49.
    Barbe F, Duran-Cantolla J, Capote F, et al. Long-term effect of continuous positive airway pressure in hypertensive patients with sleep apnoea. Am J Respir Crit Care Med. 2010;181:718–26.PubMedCrossRefGoogle Scholar
  50. 50.
    Lozano L, Tovar JL, Sampol G, et al. Continuous positive airway pressure treatment in sleep apnoea patients with resistant hypertension: a randomized controlled trial. J Hypertens. 2010;28:2161–8.PubMedCrossRefGoogle Scholar
  51. 51.
    Engleman HM, Kingshott RN, Wraith PK, Mackay TW, Deary IJ, Douglas NJ. Randomized placebo-controlled crossover trial of continuous positive airway pressure for mild sleep apnoea/Hypopnea syndrome. Am J Respir Crit Care Med. 1999;159:461–7.PubMedCrossRefGoogle Scholar
  52. 52.
    Antic NA, Catcheside P, Buchan C, et al. The effect of CPAP in normalizing daytime sleepiness, quality of life, and neurocognitive function in patients with moderate to severe OSA. Sleep. 2011;34:111–9.PubMedPubMedCentralCrossRefGoogle Scholar
  53. 53.
    Weaver TE, Maislin G, Dinges DF, et al. Relationship between hours of CPAP use and achieving normal levels of sleepiness and daily functioning. Sleep. 2007;30:711–9.PubMedPubMedCentralCrossRefGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2019
corrected publication 2019

Authors and Affiliations

  1. 1.Neurology Sleep CentreNew DelhiIndia
  2. 2.Department of Pulmonary Medicine and Sleep DisordersAll India Institute of Medical SciencesNew DelhiIndia

Personalised recommendations