Brief CommunicationAge- and gender-dependent adherence with continuous positive airway pressure therapy
Introduction
Continuous positive airway pressure (CPAP) is the standard therapy for obstructive sleep apnea (OSA) and is associated with improvements in symptoms, daytime sleepiness, neurological behavior, blood pressure, and quality of life [1], [2], [3], [4].
Although CPAP is an effective treatment, long-term adherence is challenging. Average CPAP usage ranges between 2.5 and 5.9 h/night [5], [6], [7], [8], [9], [10], [11], [12], [13], [14], [15], and between 29% and 83% of patients are non-adherent using a definition of usage time ⩾4 h/night. Recently, we published the results of a study showing that adherence to CPAP therapy in long-term patients is high and therapeutic efficacy is excellent [16]. The patients used CPAP 6.1 days/week and 6.3 h/night. Adherence was 97.0%, 91.8%, and 79.9%, respectively, for thresholds of three, four, and five h/night.
Several studies have analysed adherence to CPAP therapy, but little is known on the effects of age and gender on long-term adherence. This retrospective study resulted from a cohort of 4281 patients who received technical service on their CPAP device. The CPAP device has a memory card that stores data on usage and efficacy of therapy over the last 180 treatment days. This data was downloaded and analysed by age and gender.
Section snippets
Patients
Data from 5046 S8 CPAP devices were collected between January and June 2007. The devices had been prescribed by a physician to patients with SDB following a diagnostic sleep study and titration. Data from a memory card was downloaded during servicing, including device usage, apnea–hypopnea index (AHICPAP), mask pressure, and leak. AHICPAP is defined as reductions in flow, with more than 50% scored as hypopnea and below 20% scored as apnea. The memory card has a capacity of 180 days of data.
Results
The average age was 58 ± 11 years (82% male). Average duration of therapy was 3.5 ± 3.6 years, with a range from 30 days to 15.8 years. The mean observation period was 156 ± 25 days.
Efficacy data categorized by age group is shown in Table 1. Treatment was efficacious with a mean AHICPAP of 6.2 ± 4.8/h, and average use was 376 ± 94 min per night. There was no difference in mask pressure but residual AHI and leak tended to be greater with increased age (Fig. 1), particularly in patients over 70 years of age.
Discussion
The objective of this study was to investigate CPAP use and effectiveness in patients established on therapy for greater than 30 days. The results show that these patients are very adherent to therapy, with a mean use of more than 6 h per night and over 90% of patients using the device more than four h per night. Therapy is effective in reducing respiratory events, with the mean residual AHICPAP on therapy of 6.2/h being just outside normal limits. There were small differences in use and efficacy
Conflict of Interest
The ICMJE Uniform Disclosure Form for Potential Conflicts of Interest associated with this article can be viewed by clicking on the following link: doi:10.1016/j.sleep.2011.05.008.
Holger Woehrle works for ResMed Germany Inc. (Vice President Clinical Research and Medical Director Europe) and for the Sleep and Ventilation Center Blaubeuren, Respiratory Center Ulm.
Andrea Graml works as statistician for ResMed Germany Inc.
Gerhard
Acknowledgments
We are grateful to Glenn Richards for his review of the paper and his thoughtful comments.
References (19)
- et al.
Normalization of memory performance and positive airway pressure adherence in memory-impaired patients with obstructive sleep apnea
Chest
(2006) - et al.
Side effects of nasal continuous positive airway pressure in sleep apnea syndrome. Study of 193 patients in two French sleep centers
Chest
(1995) - et al.
Patient compliance with nasal CPAP therapy for sleep apnea
Chest
(1986) - et al.
Long-term compliance rates to continuous positive airway pressure in obstructive sleep apnea: a population based study
Chest
(2002) - et al.
Compliance with nasal continuous positive airway pressure assessed with a pressure monitor: pattern of use and influence of sleep habits
Respir Med
(2000) - et al.
The age and other factors in the evaluation of compliance with nasal continuous positive airway pressure for obstructive sleep apnea syndrome. A Cox’s proportional hazard analysis
Sleep Med
(2001) - et al.
Randomized placebo-controlled crossover trial of continuous positive airway pressure for mild sleep apnea/hypopnea syndrome
Am J Respir Crit Care Med
(1999) - et al.
Randomized placebo-controlled trial of continuous positive airway pressure on blood pressure in the sleep apnea–hypopnea syndrome
Am J Respir Crit Care Med
(2001) - et al.
Relationship between hours of CPAP use and achieving normal levels of sleepiness and daily functioning
Sleep
(2007)
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