title: Evidence of interrelated side effects with reduced compliance in patients treated with nasal continuous positive airway pressure.
abstract: OBJECTIVE
  Patients treated for obstructive sleep apnea syndrome (OSAS) with nasal continuous positive airway pressure (nCPAP) often have side effects and poor compliance. Our objectives were to explore their side effects when treated with nCPAP and to validate the association of a side effect syndrome with the outcomes of sleep quality, daytime sleepiness and nCPAP compliance.
  
  
  METHODS
  Prospective exploratory and subsequent validation study using questionnaires was performed in a tertiary-care sleep-disorders clinic. Consecutive patients with polysomnographic diagnosis and nCPAP titrations treated at least 3 months with single-pressure nCPAP were studied. In the first survey, 114 patients were questioned of whom 89 (78%) qualified for exploratory analysis. In the validation survey of 122 patients, 104 (85%) were studied. Subjects were interviewed and their nCPAP meters were queried.
  
  
  RESULTS
  In the first survey, 3 side effects were often found together and each found to be correlated to compliance: mouth leak with nCPAP, nasal congestion, and taking off the mask prematurely. In the validation study, 34% of participants met a syndrome definition with at least 2 of 3 major side effects. Mean (SD) compliance was lower in patients with the syndrome: 4.97 (1.98) vs. 6.42 (1.56) hours per night (p=0.0001). Poor sleep quality and lower satisfaction with nCPAP were associated with the syndrome.
  
  
  CONCLUSIONS
  The syndrome of mouth leak, taking off the nCPAP mask prematurely and nasal congestion is frequent in patients treated with nCPAP. This is associated with lower compliance and poor sleep quality.
authors.affiliation: Dept. of Medicine, Mount Sinai Hosp. Ctr., 5690 Cavendish Blvd, Code St- Luc (Montreal) Quebec, Canada H4W 1S7; Royal Victoria Div. of Clin. Epidemiol., Dept. of Epidemiol. and Biostatistics, McGill Univ., Montreal, Canada. marc.baltzan@clinepi.mcgill.ca
authors.forename: Marcel A
authors.initials: MA
authors.lastname: Baltzan
authors.forename: Osama
authors.initials: O
authors.lastname: Elkholi
authors.forename: Norman
authors.initials: N
authors.lastname: Wolkove
mesh_terms: D000328:Adult; D000368:Aged; D045422:Continuous Positive Airway Pressure / Q000009:adverse effects* / Q000295:instrumentation; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008397:Masks / Q000009:adverse effects; D008875:Middle Aged; D010349:Patient Compliance; D017060:Patient Satisfaction; D015203:Reproducibility of Results; D020181:Sleep Apnea, Obstructive / Q000628:therapy*; D016896:Treatment Outcome