The Positive Airway Pressure Therapy Compliance In Mild OSAS

Yıl 2022, Cilt: 4 Sayı: 1, 13 - 19, 29.01.2022

Sezgi Şahin Duyar , Deniz Çelik , Funda Aksu , Selma Fırat

https://doi.org/10.46310/tjim.888147

Öz

Introduction: This study is designed to determine the factors for predicting the PAP compliance in mild obstructive sleep apnea syndrome (OSAS) for improving the cost-effectiveness in the treatment choices of these patients.
Method: The study group comprises 27 mild OSAS patients who underwent automatic positive airway pressure (APAP) titration between July 2016 and December 2017. Demographic, clinic and polysomnographic characteristics of the patients were retrospectively evaluated. Compliance with PAP treatment was defined as the usage of 5 nights/week and 4 hours/night at least. Data of compliant patients were statistically compared with non-compliant patients.
Results: Most of the patients (23 patients, 85,2%) were prescribed APAP devices. Acceptable compliance at the end of the first year of therapy was achieved by 11 patients (40,2%) whereas 8 patients used PAP device 2 months at most (29,6%) The remaining 8 patients had not taken the device at all and were considered as non-adherent to PAP treatment (29,6%). The nonadherent/non-compliant group showed statistically the same demographic, clinic, and polysomnographic characteristics when compared to the compliant group. The level of maximum pressure during the titration test was lower in the compliant group (p=0,040).
Conclusion: The sleep-related symptoms, scores of ESS or polysomnographic parameters can not be used to predict compliance for mild OSAS. The patients with mild OSAS, especially the ones who reach higher maximum pressure on titration test, must be followed up closely during the first 2 months of PAP treatment to detect nonadherence/non-compliance earlier.

Anahtar Kelimeler

Obstructive Sleep Apnea, Positive airway pressure therapy, Patient Compliance

Kaynakça

• 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 Aug 1;22(5):667-89.
• Patil SP, Ayappa IA, Caples SM, Kimoff RJ, Patel SR, Harrod CG. Treatment of Adult Obstructive Sleep Apnea with Positive Airway Pressure: An American Academy of Sleep Medicine Clinical Practice Guideline. J Clin Sleep Med. 2019 Feb 15;15(2):335-43. doi: 10.5664/jcsm.7640.
• Izci B, Ardic S, Firat H, Sahin A, Altinors M, Karacan I. Reliability and validity studies of the Turkish version of the Epworth Sleepiness Scale. Sleep Breath. 2008 May;12(2):161-8. doi: 10.1007/s11325-007-0145-7.
• Berry RB, Brooks R, Gamaldo CE, Harding SM, Lloyd RM, Marcus CL, Vaughn BV. The American Academy of Sleep Medicine. The AASM Manual for the Scoring of Sleep and Associated Events: Rules, Terminology and Technical Specifications. 2015. Version 2.3. Darien, Illinois: American Academy of Sleep Medicine.
• Marshall NS, Neill AM, Campbell AJ, Sheppard DS. Randomised controlled crossover trial of humidified continuous positive airway pressure in mild obstructive sleep apnoea. Thorax. 2005 May;60(5):427-32. doi: 10.1136/thx.2004.032078.
• Barnes M, McEvoy RD, Banks S, Tarquinio N, Murray CG, Vowles N, Pierce RJ. Efficacy of positive airway pressure and oral appliance in mild to moderate obstructive sleep apnea. Am J Respir Crit Care Med. 2004 Sep 15;170(6):656-64. doi: 10.1164/rccm.200311-1571OC.
• Barnes M, Houston D, Worsnop CJ, Neill AM, Mykytyn IJ, Kay A, Trinder J, Saunders NA, Douglas McEvoy R, Pierce RJ. A randomized controlled trial of continuous positive airway pressure in mild obstructive sleep apnea. Am J Respir Crit Care Med. 2002 Mar 15;165(6):773-80. doi: 10.1164/ajrccm.165.6.2003166.
• Engleman HM, McDonald JP, Graham D, Lello GE, Kingshott RN, Coleman EL, Mackay TW, Douglas NJ. Randomized crossover trial of two treatments for sleep apnea/hypopnea syndrome: continuous positive airway pressure and mandibular repositioning splint. Am J Respir Crit Care Med. 2002 Sep 15;166(6):855-9. doi: 10.1164/rccm.2109023.
• Monasterio C, Vidal S, Duran J, Ferrer M, Carmona C, Barbé F, Mayos M, Gonzalez-Mangado N, Juncadella M, Navarro A, Barreira R, Capote F, Mayoralas LR, Peces-Barba G, Alonso J, Montserrat JM. Effectiveness of continuous positive airway pressure in mild sleep apneahypopnea syndrome. Am J Respir Crit Care Med. 2001 Sep 15;164(6):939-43. doi: 10.1164/ajrccm.164.6.2008010.
• Qaseem A, Holty JE, Owens DK, Dallas P, Starkey M, Shekelle P; Clinical Guidelines Committee of the American College of Physicians. Management of obstructive sleep apnea in adults: A clinical practice guideline from the American College of Physicians. Ann Intern Med. 2013 Oct 1;159(7):471-83. doi: 10.7326/0003-4819-159-7-201310010-00704.
• Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep. 1991 Dec;14(6):540-5. doi: 10.1093/sleep/14.6.540.
• Baldwin CM, Griffith KA, Nieto FJ, O’Connor GT, Walsleben JA, Redline S. The association of sleepdisordered breathing and sleep symptoms with quality of life in the Sleep Heart Health Study. Sleep. 2001 Feb 1;24(1):96-105. doi: 10.1093/sleep/24.1.96.
• Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med. 1993 Apr 29;328(17):1230-5. doi: 10.1056/NEJM199304293281704.
• Peppard PE, Young T, Palta M, Skatrud J. Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med. 2000 May 11;342(19):1378-84. doi: 10.1056/NEJM200005113421901.
• Nieto FJ, Young TB, Lind BK, Shahar E, Samet JM, Redline S, D’Agostino RB, Newman AB, Lebowitz MD, Pickering TG. Association of sleep-disordered breathing, sleep apnea, and hypertension in a large communitybased study. Sleep Heart Health Study. JAMA. 2000 Apr 12;283(14):1829-36. doi: 10.1001/jama.283.14.1829. Erratum in: JAMA 2002 Oct 23-30;288(16):1985.
• Shahar E, Whitney CW, Redline S, Lee ET, Newman AB, Nieto FJ, O’Connor GT, Boland LL, Schwartz JE, Samet JM. Sleep-disordered breathing and cardiovascular disease: cross-sectional results of the Sleep Heart Health Study. Am J Respir Crit Care Med. 2001 Jan;163(1):19-25. doi: 10.1164/ajrccm.163.1.2001008.
• Marin JM, Carrizo SJ, Vicente E, Agusti AG. Longterm cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study. Lancet. 2005 Mar 19-25;365(9464):1046-53. doi: 10.1016/S0140-6736(05)71141-7.
• Reichmuth KJ, Austin D, Skatrud JB, Young T. Association of sleep apnea and type II diabetes: a population-based study. Am J Respir Crit Care Med. 2005 Dec 15;172(12):1590-5. doi: 10.1164/rccm.200504-637OC.
• Drager LF, Bortolotto LA, Lorenzi MC, Figueiredo AC, Krieger EM, Lorenzi-Filho G. Early signs of atherosclerosis in obstructive sleep apnea. Am J Respir Crit Care Med. 2005 Sep 1;172(5):613-8. doi: 10.1164/rccm.200503-340OC.
• Duchna HW, Stoohs R, Guilleminault C, Christine Anspach M, Schultze-Werninghaus G, Orth M. Vascular endothelial dysfunction in patients with mild obstructive sleep apnea syndrome. Wien Med Wochenschr. 2006 Nov;156(21-22):596-604. doi: 10.1007/s10354-006-0341-2.
• Littner MR. Mild obstructive sleep apnea syndrome should not be treated. Con. J Clin Sleep Med. 2007 Apr 15;3(3):263-4.
• Morgenthaler TI, Kapen S, Lee-Chiong T, Alessi C, Boehlecke B, Brown T, Coleman J, Friedman L, Kapur V, Owens J, Pancer J, Swick T; Standards of Practice Committee; American Academy of Sleep Medicine. Practice parameters for the medical therapy of obstructive sleep apnea. Sleep. 2006 Aug;29(8):1031-5.
• Whitelaw WA, Brant RF, Flemons WW. Clinical usefulness of home oximetry compared with polysomnography for assessment of sleep apnea. Am J Respir Crit Care Med. 2005 Jan 15;171(2):188-93. doi:10.1164/rccm.200310-1360OC.
• Sağmen SB, Parmaksız ET, Cömert SŞ, Fidan A, Salepçi B. Liver functions in patients with obstructive sleep apnea syndrome. The European Research Journal. 2018;4(4):349-55. doi: 10.18621/eurj.381906.
• Engleman HM, Martin SE, Deary IJ, Douglas NJ. Effect of CPAP therapy on daytime function in patients with mild sleep apnoea/hypopnoea syndrome. Thorax. 1997 Feb;52(2):114-9. doi: 10.1136/thx.52.2.114.