title: Compliance in sleep apnoea therapy: influence of home care support and pressure mode.
abstract: Continuous positive airway pressure (CPAP) is an effective treatment for obstructive sleep apnoea syndrome (OSAS) but therapy adherence is often low. The hypothesis that CPAP-adherence and clinical outcomes can be improved by either using an autoadjusting-CPAP (APAP) device or an intensive support was tested. A controlled parallel group study was performed with 100 newly diagnosed OSAS patients, randomised into 4 groups (n = 25 each): standard or intensive support plus either APAP or CPAP. Intensive support included education and monthly home visits for 6 months. Clinical outcome was monitored by polysomnography at CPAP initiation and, after 3 and 9 months, compliance data were downloaded from the CPAP devices. After 9 months, intensively supported patients returned for follow-up in 88 versus 68% in the standard-support-group. Daily usage (mean+/-sem 5.7+/-0.2 for intensive support versus 4.6+/-0.4 h for standard support), percentage of days used (80.4+/-2.8 versus 57.0+/-5.9%) and proportion of individual sleep time (80.6+/-3.2 versus 64.9+/-6.2%) were also higher. There was no significant difference between APAP or CPAP, (daily usage 5.2+/-0.4 versus 5.1+/-0.3 h, percentage of days 67.9+/-5.0 versus 69.2+/-4.9%, proportion of sleep time 72.5+/-5.0% versus 72.1+/-5.2%, for APAP and CPAP) but retention rate was higher with CPAP. In summary, intensive support after continuous positive airway pressure initiation, rather than the application of autoadjusting-continuous positive airway pressure, increased therapy adherence.
authors.affiliation: Dept of Pneumology, University Hospital Freiburg, Freiburg, Germany.
authors.forename: D
authors.initials: D
authors.lastname: Damjanovic
authors.forename: A
authors.initials: A
authors.lastname: Fluck
authors.forename: H
authors.initials: H
authors.lastname: Bremer
authors.forename: J
authors.initials: J
authors.lastname: Müller-Quernheim
authors.forename: M
authors.initials: M
authors.lastname: Idzko
authors.forename: S
authors.initials: S
authors.lastname: Sorichter
mesh_terms: D000704:Analysis of Variance; D045422:Continuous Positive Airway Pressure / Q000379:methods*; D005260:Female; D006699:Home Care Services; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D017286:Polysomnography; D020181:Sleep Apnea, Obstructive / Q000628:therapy*