Predictors of CPAP Non-Compliance One Year Post-Discharge in Obstructive Sleep Apnea Syndrome Patients
DOI:
https://doi.org/10.24950/rspmi.2691Keywords:
Continuous Positive Airway Pressure, Patient Compliance, Sleep Apnea, ObstructiveAbstract
Introduction: Continuous positive airway pressure (CPAP) therapy is the gold standard for obstructive sleep apnea syndrome (OSAS). However, its compliance remains a clinical challenge. This study aimed to determine the CPAP non-compliance rate one year after medical discharge and identify predictors of non-compliance.
Methods: This observational study included OSAS patients who were discharged from the Pulmonology consultation at the Unidade Local de Saúde do Alto Ave between January and November 2023, after symptom correction and demonstrating compliance to CPAP (according to the European Respiratory Society and American Academy of Sleep Medicine guidelines). One year after discharge, patients were again classified as adherent (maintaining use for ≥4 hours on ≥70% of nights) or non-adherent (remaining cases). A binary logistic regression was performed to identify predictors.
Results: A total of 403 patients were included. The
non-compliance rate one year after discharge was 28.0%. A lower Apnea-Hypopnea Index (OR = 0.939), diabetes (OR = 5.801), alcohol consumption (OR=1.018), divorced status (OR = 10.243), baseline excessive daytime sleepiness complaint (OR = 0.199), Epworth Sleepiness Scale (OR = 1.209) and lower CPAP use at discharge (OR = 0.797) were identified as independent predictors for CPAP non compliance one year after discharge.
Conclusion: Tailored follow-up strategies are essential to improve CPAP compliance, especially for high-risk patients identified through these predictors.
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1. Lévy P, Kohler M, McNicholas WT, Barbé F, McEvoy RD, Somers VK, et al. Obstructive sleep apnoea syndrome. Nat Rev Dis Primers. 2015;1:15015. doi: 10.1038/nrdp.2015.15.
2. Lavie L. Oxidative stress in obstructive sleep apnea and intermittent hypoxia--revisited--the bad ugly and good: implications to the heart and brain. Sleep Med Rev. 2015;20:27-45. doi: 10.1016/j.smrv.2014.07.003.
3. Lv R, Liu X, Zhang Y, Dong N, Wang X, He Y, et al. Pathophysiological mechanisms and therapeutic approaches in obstructive sleep apnea syndrome. Signal Transduct Target Ther. 2023;8:218. doi: 10.1038/s41392-023-01496-3.
4. Sweed RA, Elghany RA, Elganady A, Mohamed EE, Mekky JF, Elshfei M. Impact of obstructive sleep apnea on cognition, mood, and fatigue: An MRI-based study. Egyptian J Bronchol. 2023; 17. doi:10.1186/s43168-023-00247-w
5. Spicuzza L, Caruso D, Di Maria G. Obstructive sleep apnoea syndrome and its management. Ther Adv Chronic Dis. 2015;6:273-85. doi: 10.1177/2040622315590318.
6. Bonsignore MR, Randerath W, Schiza S, Verbraecken J, Elliott MW, Riha R, et al. European Respiratory Society statement on sleep apnoea, sleepiness and driving risk. Eur Respir J. 2021;57:2001272. doi: 10.1183/13993003.01272-2020.
7. Yeghiazarians Y, Jneid H, Tietjens JR, Redline S, Brown DL, El-Sherif N, et al. Obstructive Sleep Apnea and Cardiovascular Disease: A Scientific Statement From the American Heart Association. Circulation. 2021;144:e56-e67. doi: 10.1161/CIR.0000000000000988. Erratum in: Circulation. 2022;145:e775. doi: 10.1161/CIR.0000000000001043.
8. Jaspan VN, Greenberg GS, Parihar S, Park CM, Somers VK, Shapiro MD, et al. The Role of Sleep in Cardiovascular Disease. Curr Atheroscler Rep. 2024;26:249-62. doi: 10.1007/s11883-024-01207-5.
9. Kapur VK, Auckley DH, Chowdhuri S, Kuhlmann DC, Mehra R, Ramar K, et al. Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea: An American Academy of Sleep Medicine Clinical Practice Guideline. J Clin Sleep Med. 2017;13:479-504. doi: 10.5664/jcsm.6506.PMID: 28162150;
10. Parati G, Lombardi C, Hedner J, Bonsignore MR, Grote L, Tkacova R, et al. Recommendations for the management of patients with obstructive sleep apnoea and hypertension. Eur Respir J. 2013;41:523-38. doi: 10.1183/09031936.00226711.
11. Marin JM, Agusti A, Villar I, Forner M, Nieto D, Carrizo SJ, et al. Association between treated and untreated obstructive sleep apnea and risk of hypertension. JAMA. 2012;307:2169-76. doi: 10.1001/jama.2012.3418.
12. 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 Systematic Review, Meta-Analysis, and GRADE Assessment. J Clin Sleep Med. 2019;15:301-34. doi: 10.5664/jcsm.7638.
13. Rotenberg BW, Murariu D, Pang KP. Trends in CPAP adherence over twenty years of data collection: a flattened curve. J Otolaryngol Head Neck Surg. 2016;45:43. doi: 10.1186/s40463-016-0156-0.
14. Catcheside PG. Predictors of continuous positive airway pressure adherence. F1000 Med Rep. 2010;2:70. doi: 10.3410/M2-70.
15. Campos-Rodriguez F, Martinez-Alonso M, Sanchez-de-la-Torre M, Barbe F; Spanish Sleep Network. Long-term adherence to continuous positive airway pressure therapy in non-sleepy sleep apnea patients. Sleep Med. 2016;17:1-6. doi: 10.1016/j.sleep.2015.07.038.
16. Qiao M, Xie Y, Wolff A, Kwon J. Long term adherence to continuous positive Airway pressure in mild obstructive sleep apnea. BMC Pulm Med. 2023;23:320. doi: 10.1186/s12890-023-02612-3.
17. Direção-Geral da Saúde. Norma nº 022/2011: Cuidados Respiratórios Domiciliários: Prescrição de Ventiloterapia e outros equipamentos. [accessed Jan 2024 ] Available at: https://normas.dgs.min-saude.pt/wp-content/uploads/2019/09/cuidados-respiratorios-domiciliarios_prescricao-de-ventiloterapia-e-outros-quipamentos.pdf
18. Direção-Geral da Saúde. Norma nº 022/2014: Seguimento nos cuidados de saúde primários de doentes com síndrome de apneia obstrutiva do sono sob terapêutica com pressão positiva contínua. [accessed Jan 2024 ] Available at: https://www.dgs.pt/directrizes-da-dgs/orientacoes-e-circulares-informativas/orientacao-n-0222014-de-30122014-pdf.aspx
19. Jacobsen AR, Eriksen F, Hansen RW, Erlandsen M, Thorup L, Damgård MB, et al. Determinants for adherence to continuous positive airway pressure therapy in obstructive sleep apnea. PLoS One. 2017;12:e0189614. doi: 10.1371/journal.pone.0189614.
20. Martins M, Silva L, Ferreira J. Seguimento da SAOS numa Unidade de Saúde Familiar: avaliação e melhoria contínua da qualidade. Rev Port Med Geral Familiar. 2023;39:150-7. doi: 10.32385/rpmgf.v39i3.12654.
21. Conselho das Finanças Públicas. Evolução do desempenho do Serviço Nacional de Saúde em 2021 (Relatório nº 07/2022). [accessed Jan 2024 ] Available at: https://www.cfp.pt/uploads/publicacoes_ficheiros/cfp-rel-07-2022[1].pdf
22. Joymangul JS, Sekhari A, Grasset O, Moalla N. Homecare interventions as a Service model for Obstructive sleep Apnea: Delivering personalised phone call using patient profiling and adherence predictions. Int J Med Inform. 2023;170:104935. doi: 10.1016/j.ijmedinf.2022.104935.
23. Mehrtash M, Bakker JP, Ayas N. Predictors of Continuous Positive Airway Pressure Adherence in Patients with Obstructive Sleep Apnea. Lung. 2019;197:115-21. doi: 10.1007/s00408-018-00193-1.
24. Reutrakul S, Mokhlesi B. Obstructive Sleep Apnea and Diabetes: A State of the Art Review. Chest. 2017;152:1070-86. doi: 10.1016/j.chest.2017.05.009.
25. Kojima S, Saito A, Sasaki F, Hayashi M, Mieno Y, Sakakibara H, et al. Associations of diabetes mellitus and hypertension with adherence to continuous positive airway pressure therapy in male patients with obstructive sleep apnea. Fujita Med J. 2022;8:37-41. doi: 10.20407/fmj.2020-028.
26. Jeong JI, Kim HY, Hong SD, Ryu G, Kim SJ, Lee KE, et al. Upper Airway Variation and Frequent Alcohol Consumption Can Affect Compliance With Continuous Positive Airway Pressure. Clin Exp Otorhinolaryngol. 2016;9:346-51. doi: 10.21053/ceo.2015.01984.
27. Gagnadoux F, Le Vaillant M, Goupil F, Pigeanne T, Chollet S, Masson P, et al. Influence of marital status and employment status on long-term adherence with continuous positive airway pressure in sleep apnea patients. PLoS One. 2011;6:e22503. doi: 10.1371/journal.pone.0022503.
28. Barbé F, Mayoralas LR, Duran J, Masa JF, Maimó A, Montserrat JM, et al. Treatment with continuous positive airway pressure is not effective in patients with sleep apnea but no daytime sleepiness. a randomized, controlled trial. Ann Intern Med. 2001;134:1015-23. doi: 10.7326/0003-4819-134-11-200106050-00007.
29. Trindade A, Custódio C, Cabral J, Lopes T, Martins V, Aguiar M, Gonçalves I, Furtado S. Influence of excessive daytime sleepiness on the treatment adherence of obstructive sleep apnea. Sleep Med.2023;109:50-55. doi: 10.1016/j.sleep.2023.06.015.
30. Milinovic K, Pavlinac Dodig I, Lusic Kalcina L, Pecotic R, Ivkovic N, Valic M, et al. Adherence to CPAP Therapy in Obstructive Sleep Apnea: A Prospective Study on Quality of Life and Determinants of Use. Eur J Investig Health Psychol Educ. 2024;14:2463-75. doi: 10.3390/ejihpe14090163.
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