Identifying Affecting Factors on Acceptance with CPAP on the First Night of PAP Titration in Sleep Clinic on Patients with Obstructive Sleep Apnea

Document Type : Original

Authors

1 Otorhinolaryngology Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.

2 Occupational Sleep Research Center, Baharloo Hospital, Tehran University of Medical Sciences, Tehran, Iran.

3 Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran.

Abstract

Introduction:
This research examined the causes of low acceptance with Continuous Positive Airway Pressure Continuous Positive Airway Pressure (CPAP) especially anatomical causes and if eliminating them would result in increasing its adherence.  
Materials and Methods:
This cross sectional study was performed on patients with moderate to severe Obstructive Sleep Apnea Obstructive Sleep Apnea (OSA) undergoing PAP titration in the sleep clinic.  CPAP acceptance was evaluated by visual analog scale (VAS) about mask and sleep satisfaction and the possibility of using CPAP in the future, mask complications, physical examination of the upper airway and polysomnographic (PSG) results before and after titration.            
Results:
participants were divided into three groups of non-acceptant, semi-acceptant and acceptant with CPAP based on the satisfaction of the mask and sleep. There were no significant differences between groups based on age, gender, education, BMI and polysomnographic variables.  With a study of mask complication, there were significant differences among groups for dry mouth, mask leakage and cold air. (p<0.05) The severity of septal deviation, high arch palate, mallampati, retrognathia and maxillary hypoplasia in the acceptant group was less than the other two groups, but it was not statistically significant.    
Conclusions:
Satisfaction with the sleep and the mask on the first night of titration will significantly increase the likelihood of using CPAP in the future. A number of the pathological physical examinations were lower in the acceptant group than two other groups, but were not significant.

Keywords

Main Subjects

References

  1. Bilston L, Gandevia S. Biomechanical properties of the human upper airway and their effect on its behavior during breathing and in obstructive sleep apnea. Journal of Applied Physiology. 2014; 116(3): 314-24.
  2. Park P, Kim J, Song Y, Lim J, Cho S, Won T, et al. Influencing factors on CPAP adherence and anatomic characteristics of upper airway in OSA subjects. Medicine. 2017;96(51).
  3. Kushida C, Littner M, Hirshkowitz M, Morgenthaler T, Alessi C, Bailey D, et al. Practice parameters for the use of continuous and bilevel positive airway pressure devices to treat adult patients with sleep-related breathing disorders. Sleep. 2006;29(3):375-80
  4. Freedman N. Positive airway pressure treatment for obstructive sleep apnea: Elsevier; 2017.
  5. Jenkinson C, Davies R, Mullins R, Stradling J. Comparison of therapeutic and sub therapeutic nasal continuous positive airway pressure for obstructive sleep apnoea. The Lancet. 1999;353(9170):2100-5.
  6. Pepperell J, Ramdas Singh-Dow S, Crosthwaite N, Mullins R, Jenkinson C, Stradling J, et al. Ambulatory blood pressure after therapeutic and sub therapeutic nasal continuous positive airway pressure for obstructive sleep apnoea. The Lancet. 2002;359(9302):204-10.
  7. Martínez-García M, Soler-Cataluña J, Ejarque-Martinez L, Soriano Y, Román-Sánchez P, Illa F, et al. Continuous positive airway pressure treatment reduces mortality in patients with ischemic stroke and obstructive sleep apnea: a 5-year follow-up study. American journal of respiratory and critical care medicine. 2009;180(1):36-41.
  8. Milleron O, Pillière R, Foucher A, de Roquefeuil F, Aegerter P, Jondeau G, et al. Benefits of obstructive sleep apnoea treatment in coronary artery disease: a long-term follow-up study. European heart journal. 2004;25(9):728-34.
  9. Marin J, Carrizo S, Vicente E, Agusti A. Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study. The Lancet. 2005; 365 (9464): 1046-53.
  10. Campos-Rodriguez F, Pena-Grinan N, Reyes-Nunez N, De la Cruz-Moron I, Perez-Ronchel J, De la Vega-Gallardo F, et al. Mortality in obstructive sleep apnea-hypopnea patients treated with positive airway pressure. Chest. 2005;128(2):624-33.

 

  1. Mcardle N, Devereux G, Heidarnejad H, Engelmann H, Mackay T, Douglas N. Long-term use of CPAP therapy for sleep apnea/hypopnea syndrome. American journal of respiratory and critical care medicine. 1999;159(4):1108-14.
  2. Kohler M, Smith D, Tippett V, Stradling J. Predictors of long-term compliance with continuous positive airway pressure. Thorax. 2010; 65(9):829-32.
  3. Weaver T, Sawyer A. Adherence to continuous positive airway pressure treatment for obstructive sleep apnea: implications for future interventions. The Indian journal of medical research. 2010: 131: 245.
  4. Berry R. Improving CPAP compliance-man more than machine. Sleep medicine. 2000;1(3):175.
  5. Massie C, Hart R, Peralez K, Richards G. Effects of humidification on nasal symptoms and compliance in sleep apnea patients using continuous positive airway pressure. Chest. 1999;116(2):403-8                                                                            
  6. Pépin J, Leger P, Veale D, Langevin B, Robert D, Lévy P. Side effects of nasal continuous positive airway pressure in sleep apnea syndrome: study of 193 patients in two French sleep centers. Chest. 1995;107(2):375-81
  7. Hui D, Choy D, Li T, Ko F, Wong K, Chan J, et al. Determinants of continuous positive airway pressure compliance in a group of Chinese patients with obstructive sleep apnea. Chest. 2001; 120(1): 170-6.
  8. Drake C, Day R, Hudgel D, Stefadu Y, Parks M, Syron M, et al. Sleep during titration predicts continuous positive airway pressure compliance. Sleep. 2003;26(3):308-11.
  9. Lee C, Leow L, Song P, Li H, Ong T. Acceptance and adherence to continuous positive airway pressure therapy in patients with obstructive sleep apnea (OSA) in a Southeast Asian privately funded healthcare system. Sleep Science. 2017; 10(2):57.
  10. Chandrashekaraiah R, Shaman Z, Auckley D. Impact of upper airway surgery on CPAP compliance in difficult-to-manage obstructive sleep apnea. Archives of Otolaryngology–Head & Neck Surgery. 2008;134(9):926-30
  11. Ghosh D, Allgar V, Elliott M. Identifying poor compliance with CPAP in obstructive sleep apnoea: a simple prediction equation using data after a two-week trial. Respiratory medicine. 2013;107(6):
    936-42.
  12. Sin D, Mayers I, Man G, Pawluk L. Long-term compliance rates to continuous positive airway pressure in obstructive sleep apnea: a population-based study. Chest. 2002;121(2):430-5.
Iranian Journal of Otorhinolaryngology
Volume 35, Issue 6
November and December 2023
Pages 303-309

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