Interventions to improve compliance in sleep apnea patients previously non-compliant with continuous positive airway pressure

Abstract

Study objectives: Despite widespread agreement that continuous positive airway pressure is effective therapy for obstructive sleep apnea, it is estimated that 50% of patients recommended for therapy are noncompliant 1 year later. Interventions to improve compliance in such patients have not been studied. We evaluated a 2 phase intervention program to improve compliance in sleep apnea patients previously noncompliant with continuous positive airway pressure.

Methods: 204 patients with previously diagnosed obstructive sleep apnea and noncompliant with continuous positive airway pressure were enrolled. Phase 1 evaluated standard interventions to improve therapy compliance, including mask optimization, heated humidification, topical nasal therapy, and sleep apnea education. Persistently noncompliant patients proceeded to phase 2, where compliance was compared in double-blind randomized fashion between standard continuous positive airway pressure and flexible bilevel positive airway pressure.

Results: 49 (24%) of 204 previously noncompliant patients became compliant (average nightly use > or =4 hours) after standard interventions. Then 104 of the 155 persistently noncompliant patients agreed to continue and were randomized to either CPAP or flexible bilevel positive airway pressure retitration and treatment for an additional ninety days. At follow-up 15 (28%) of the 53 randomized to CPAP and 25 (49%) of the 51 randomized to flexible bilevel positive airway pressure (p = 0.03) achieved compliance.

Conclusions: A two phase intervention program, first employing standard interventions, followed by a change to flexible bilevel airway pressure, can achieve improved compliance in patients previously noncompliant with continuous positive airway pressure.

Figures

Figure 1

Flow Chart Demonstrating Protocol Organization

Figure 2

Comparison of BiFlex pressure profiles to standard bilevel profile. Upward deflection corresponds to increased pressure during inspiration. BiFlex Off = standard bilevel profile. BiFlex = 1, gain or “comfort setting” of 1. BiFlex = 2, gain or “comfort setting” of 2. BiFlex = 3, gain or “comfort setting” of 3.

Figure 3

Mean daily therapy usage (h/day) at completion of phase 1 and completion of phase 2 for patients randomly assigned to CPAP (left bars) or BiFlex (right bars) during phase 2. * p

Figure 4

Percentage (%) of patients using CPAP or BiFlex therapy ≥4 h/day at the conclusion of phase 2 (left bars), and percent increase in therapy daily use from the completion of phase 1 to the completion of phase 2 for patients assigned to CPAP or BiFlex (right bars). * p