title: Removal of the CPAP Therapy Device During Sleep and Its Association With Body Position Changes and Oxygen Desaturations.
abstract: BACKGROUND
  Some patients with obstructive sleep apnea syndrome remove the CPAP device during sleep, although they start CPAP at bedtime. We hypothesized that body position changes and oxygen desaturations may be associated with patient removal of the CPAP device.
  
  
  METHODS
  We consecutively enrolled 36 poor CPAP adherers and 25 good CPAP adherers. Body positions and oxygen desaturations were evaluated when these subjects used CPAP during sleep for 2 nights, permitting the removal of the CPAP device during the recording.
  
  
  RESULTS
  Twelve poor CPAP adherers exhibited subject removal of the CPAP device within 4 h from the start of body position recording. The frequency of body position changes was significantly higher within 15 min before the CPAP removal than during other periods when CPAP was used. At the same time, oxygen desaturations were significantly more frequent within 15 min before CPAP removal than during other periods when CPAP was used. In addition, the majority (66.7%) of the CPAP removal events were followed by a change from a supine position to a non-supine position within 5 min. The number of body position changes during the first 4-h recording was significantly higher in the poor CPAP adherers who had removed their CPAP device compared with the poor CPAP adherers who had not removed their device. However, the number of body position changes or oxygen desaturation index under CPAP during the first 4-h recording was not significantly different between the poor CPAP adherers and good CPAP adherers.
  
  
  CONCLUSIONS
  Our findings are the first to indicate associations among CPAP removal, body position changes, and oxygen desaturations during sleep in poor CPAP adherers. However, our findings also indicated that most good CPAP adherers make frequent body position changes without removal of CPAP device, suggesting that patients can adapt to the discomfort of CPAP therapy at the time of body position changes.
authors.affiliation: Department of Geriatric Medicine, Graduate School of Medicine, University of Tokyo, Bunkyo-ku, Tokyo, Japan. yamayasu-tky@umin.ac.jp.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Yamaguchi
authors.affiliation: Department of Geriatric Medicine, Graduate School of Medicine, University of Tokyo, Bunkyo-ku, Tokyo, Japan.
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Hibi
authors.affiliation: Department of Geriatric Medicine, Graduate School of Medicine, University of Tokyo, Bunkyo-ku, Tokyo, Japan.
authors.forename: Masaki
authors.initials: M
authors.lastname: Ishii
authors.affiliation: Department of Geriatric Medicine, Graduate School of Medicine, University of Tokyo, Bunkyo-ku, Tokyo, Japan.
authors.forename: Yoko
authors.initials: Y
authors.lastname: Hanaoka
authors.affiliation: Department of Geriatric Medicine, Graduate School of Medicine, University of Tokyo, Bunkyo-ku, Tokyo, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yamamoto
authors.affiliation: Department of Geriatric Medicine, Graduate School of Medicine, University of Tokyo, Bunkyo-ku, Tokyo, Japan.
authors.forename: Yasuyoshi
authors.initials: Y
authors.lastname: Ouchi
authors.affiliation: Department of Geriatric Medicine, Graduate School of Medicine, University of Tokyo, Bunkyo-ku, Tokyo, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Akishita
mesh_terms: D000368:Aged; D045422:Continuous Positive Airway Pressure; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000032:analysis; D010349:Patient Compliance / Q000706:statistics & numerical data*; D017286:Polysomnography; D011187:Posture; D012890:Sleep; D020181:Sleep Apnea, Obstructive / Q000628:therapy*; D013997:Time Factors
chemical_list: D010100:Oxygen
keywords: adherence; body position changes; non-supine; obstructive sleep apnea syndrome; positive airway pressure; supine