title: CPAP adherence and partial upper airway obstruction during sleep.
abstract: Nasal continuous positive airway pressure (CPAP) is the treatment of choice in severe obstructive sleep-disordered breathing (SDB). Partial obstruction is usually considered as mild SDB with poor CPAP adherence. In a retrospective study, we investigated the occurrence of partial obstruction in 233 age and BMI-matched male-female pairs and its impact on CPAP adherence after one year using static-charge-sensitive bed. Women had less SDB compared with men (21.8 vs 31.7% of time in bed (TIB), p < 0.001), less periodic breathing (5.8 vs 15.6%, p < 0.001) but tended to have more partial obstruction (10.5 vs 7.5%, p = 0.174). In women, partial obstruction accounted for 50.2% of breathing abnormalities, in men 37.2% (p < 0.001). CPAP adherence was 60.5% in women and 56.9% in men. When taking into account the proportion of partial obstruction (< or = 5 vs > 5% of TIB) or periodic breathing, there were no differences in women's CPAP adherence (p = 0.130 and p = 0.148, respectively). Men with periodic breathing over 5% of TIB tended to be more adherent to CPAP, (p = 0.052). The high occurrence of partial obstruction in both genders and particularly in women suggests that the apnea-hypopnea index underestimates the occurrence of SDB. There are no concerns of low adherence when treating symptomatic partial obstruction during sleep. Partial obstruction may not represent mild SDB but a different entity.
authors.affiliation: Department of Pulmonary Diseases, Turku University Central Hospital, Turku, Finland. ulla.anttalainen@tyks.fi
authors.forename: Ulla
authors.initials: U
authors.lastname: Anttalainen
authors.forename: Tarja
authors.initials: T
authors.lastname: Saaresranta
authors.forename: Nea
authors.initials: N
authors.lastname: Kalleinen
authors.forename: Jenni
authors.initials: J
authors.lastname: Aittokallio
authors.forename: Tero
authors.initials: T
authors.lastname: Vahlberg
authors.forename: Olli
authors.initials: O
authors.lastname: Polo
mesh_terms: D000328:Adult; D000368:Aged; D000403:Airway Resistance / Q000502:physiology; D001513:Beds; D015992:Body Mass Index; D045422:Continuous Positive Airway Pressure / Q000523:psychology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D010349:Patient Compliance / Q000523:psychology*; D017286:Polysomnography / Q000295:instrumentation*; D012189:Retrospective Studies; D012737:Sex Factors; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D014939:Work of Breathing / Q000502:physiology