Compliance Information

Nasal Continuous Positive Airway Pressure in the Treatment of Obstructive Sleep Apnea. Six and eighteen month compliance rates for patients using n-CPAP. CPAP provides a pneumatic splint of the upper airway resulting in an increase in the pharyngeal cross sectional area. A full night's polysomnogram demonstrates the optimal CPAP pressure at which consolidated sleep occurs in all sleep positions and stages of sleep. If most apneas and hypopneas are prevented in NREM, and SaO2 stays above 90% in REM withour frequent obstructive breathing events, and an adequate pressure has been identified. There are no definite contraindications to CPAP use, and serious complications appear to be extremely rare. The most common adverse effects are nasal dryness, nasal congestion, rhinorrhea, and sneezing often treated by humidification. Another limiting factor is claustrophobia seen in approximately 2% to 5% of patients trying CPAP in the laboratory. Long-term compliance with CPAP was studied in 121 patients. After 6 months 74.4% were compliant; after 18 months 66.6% reported compliance of symptomatic benefit and general dislike of the system. Compliance of patients followed up at the sleep disorders center (SDC) was: at 6 months 77.8 and at 12 months 72.2, whereas the compliance of patients followed up by the primary care MD (PMD) was 71.0% at 6 months and 61.3 at 12 months. Often, problems that prevent the patient from complying with CPAP can be solved in regular follow-up visits. Author's Conclusion: CPAP is likely to remain the first choice for treatment of obstructive apnea. Also patients tended toward greater compliance when they received regular follow-up care by a physician with significant experience with this treatment modality. Q. Stokes Dickins, Nancy A Jenkins, Richard Mrad, Paula K. Schweitzer, James K. Walsh. OPERATIVE TECHNIQUES IN OTOLARYNGOLOGY-HEAD AND NECK SURGERY 1991, Vol. 2, No. 2