Chest
Volume 121, Issue 2, February 2002, Pages 430-435
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Clinical Investigations
Sleep and Breathing
Long-term Compliance Rates to Continuous Positive Airway Pressure in Obstructive Sleep Apnea: A Population-Based Study

https://doi.org/10.1378/chest.121.2.430Get rights and content

Study objectives

To determine long-term compliance rates to continuous positive airway pressure (CPAP) therapy in patients with obstructive sleep apnea enrolled in a comprehensive CPAP program in the community.

Design

Prospective cohort longitudinal study.

Setting

University sleep disorders center.

Patients

Two hundred ninety-six patients with an apnea-hypopnea index (AHI) ≥20/h on polysomnography.

Interventions

A CPAP device equipped with a monitoring chip was supplied. Within the first week, daily telephone contacts were made. Patients were seen at 2 weeks, 4 weeks, 3 months, and 6 months.

Results

Of the 296 subjects enrolled, 81.1% were males. Mean ± SD AHI was 64.4 ± 34.2/h of sleep; age, 51 ± 11.7 years; and body mass index, 35.2 ± 7.9 kg/m2. The mean duration of CPAP use was 5.7 h/d at 2 weeks, 5.7 h/d at 4 weeks, 5.9 h/d at 3 months, and 5.8 h/d at 6 months. The percentage of patients using CPAP ≥3.5 h/d was 89.0% at 2 weeks, 86.6% at 4 weeks, 88.6% at 3 months, and 88.5% at 6 months. There was a decrease in the Epworth Sleepiness Scale (ESS) score of 44% by 2 weeks of therapy. The patients continue to improve over the follow-up period, with the lowest mean ESS score observed at 6 months. With multiple regression analysis, three variables were found to be significantly correlated with increased CPAP use: female gender, increasing age, and reduction in ESS score.

Conclusion

A population-based CPAP program consisting of consistent follow-up, “troubleshooting,” and regular feedback to both patients and physicians can achieve CPAP compliance rates of> 85% over 6 months.

Section snippets

General Program Description

This study was conducted at the University of Alberta Hospital (UAH) Sleep Disorders Laboratory, in Edmonton, AB, which is the only accredited sleep facility to conduct supervised polysomnography in Northern Alberta. Funding for the CPAP devices were provided by the Alberta Aids to Daily Living, a government agency that oversees the provision of Respiratory Health Services and respiratory equipment to the citizens of Alberta. Funding was also provided for hiring a dedicated CPAP clinic nurse

Study Cohort

During the study period, 1,007 patients underwent diagnostic polysomnography for a suspected sleep disorder. Of these, 296 patients (29.4%) had an AHI ≥20/h and were invited to join the CPAP program. No patients refused, and all were followed up for the duration of the study period. We did not lose any patients during follow-up. The baseline demographic and sleep study features for patients with and without OSA are shown in Table 1 . Patients with OSA were slightly older, more obese, and more

Discussion

This population-based CPAP program produced several interesting findings. First, we observed that > 92% of OSA patients in this program used CPAP for > 2.5 h/night on average for the first 6 months of the program. Even using a more stringent criterion for compliance (ie, ≥4 h of CPAP use per night), 84% of the eligible CPAP recipients were compliant with CPAP over the first 6 months of the program. Second, as expected, with the application of and compliance with CPAP therapy, there was a marked

ACKNOWLEDGMENT

The authors acknowledge the technical assistance of Rhoda Schreiner, Doreen Kelsey, and Doug Willms at the University of Alberta Hospital Sleep Disorders Laboratory; Dianne Chaba for preparation of the article; and Rod Rousseau from Alberta Aids to Daily Living Program, Alberta Health and Welfare.

References (19)

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Dr. Sin is supported by a New Investigator Award from the Canadian Institutes of Health Research.

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