Compliance with nasal CPAP can be improved by simple interventions
Sleep Disorders Center, University of Michigan, Ann Arbor, USA. Sleep
(Impact Factor: 4.59).
Effectiveness of continuous positive airway pressure (CPAP) as a treatment of obstructive sleep apnea can be limited by poor compliance, but little is known about how to improve compliance. We performed a randomized, controlled clinical trial among 33 subjects of two interventions to improve compliance. One group of subjects received weekly phone calls to uncover any problems and encourage use, another received written information about sleep apnea and the importance of regular CPAP use, and a third served as control subjects. We found that intervention improved CPAP compliance (p = 0.059) and that the effect was particularly strong when intervention occurred during the first month of CPAP treatment (p = 0.004). Although the sample size did not allow definitive investigation of other explanatory variables, subjects with lower levels of education or those with relatives who used CPAP may have benefited from intervention more than other subjects. We conclude that simple, inexpensive efforts to improve compliance with CPAP can be effective, especially when applied at the start of CPAP treatment, but optimal intervention may vary with certain patient characteristics.
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- " The delivery of intensive patient education was looked at in many different ways.      Within each method of communicating patient education information there were three parts: the diagnosis of OSA, the treatment of OSA and remedies to CPAP problems that patients may experience. Education was given on the definition and pathophysiology of OSA. "
Available from: Amy M Sawyer
- "N at 3mo Chervin et al., 1997 RCT 33 (Experimental group [calls]=12; Experimental group [literature]=14; Control group =7) Positive reinforcement (weekly telephone calls OR two printed documents compared with CPAP use alone) "
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ABSTRACT: Adherence to continuous positive airway pressure (CPAP) treatment for obstructive sleep apnoea (OSA) is a critical problem. Poor adherence (30-60%) to CPAP is widely recognized as a significant limiting factor in treating OSA, reducing the overall effectiveness of the treatment and leaving many OSA patients at heightened risk for co-morbid conditions, impaired function and quality of life. The extant literature examining adherence to CPAP provides critical insight to measuring adherence outcomes, defining optimal adherence levels, and predicting CPAP adherence. This research has revealed salient factors that are associated with or predict CPAP adherence and may guide the development of interventions to promote CPAP adherence. Over the past 10 years, intervention studies to promote CPAP adherence have incorporated a multitude of strategies including education, support, cognitive behavioural approaches, and mixed strategies. This review of the current status of research on CPAP adherence will (i) synthesize the extant literature with regard to measuring, defining, and predicting CPAP adherence; (ii) review published intervention studies aimed at promoting CPAP adherence; and (iii) suggest directions for future empiric study of adherence to CPAP that will have implications for translational science. Our current understanding of CPAP adherence suggests that adherence is a multi-factorial, complex clinical problem that requires similarly designed approaches to effectively address poor CPAP adherence in the OSA population.
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- "OSA is widely treated by continuous positive airway pressure (CPAP) through a nasal mask, but alternative treatments are required for those patients who cannot tolerate CPAP or who are not interested in using such a device. Various studies have demonstrated that up to half of the patients supplied with CPAP are not using the device regularly (Nino Murcia et al., 1989; Kribbs et al., 1993; Engleman et al., 1994; Chervin et al., 1997; Wright et al., 1997). OSA has also been treated surgically. "
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ABSTRACT: The aim of this study was to determine the severity of side effects and the influence on snoring and the AHI (apnoea-hypopnoea index = number of apnoeas and hypopnoeas per hour recording) of an anterior mandibular positioning device (AMP device) for treatment of snoring and obstructive sleep apnoea. Questionnaires were mailed to a consecutive series of 30 patients who had started treatment with an AMP device. The mean follow-up interval from receiving an AMP device to answering the questionnaire was 22 months. The perceived degree of sore teeth increased statistically significantly (p < 0.01) as a result of the AMP device treatment, but there was no increase in the degree of facial pain, salivation, or temporomandibular joint pain. The AMP device treatment resulted in a statistically significant reduction (p < 0.01) of the mean AHI and of the mean percentage of the recording time with loud snoring (p < 0.05). Twenty-two patients out of 30 were still using the device at the time of follow-up. In conclusion, AMP device treatment was associated with only mild side effects and resulted in a statistically significant reduction of the AHI and of the percentage of the recording time with loud snoring.
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