CPAP compliance – the first year and beyond

Introduction For moderate to severe obstructive sleep apnea, the most common treatment is the use of a Continuous Positive Airway Pressure (CPAP) or Automatic Positive Airway Pressure (APAP) device. This device ‘splints’ the patient’s airway open during sleep by means of a flow of pressurized positive air into the throat. Despite the effectiveness of this therapy, long-term compliance with CPAP/APAP therapy has been difficult for many patients. The purpose of this study was to determine the CPAP/APAP compliance of patients after one year of starting on CPAP/APAP therapy. Materials and methods Initially, patients were referred to private sleep diagnostic testing facilities (Respiratory Homecare Solutions {RHS}) by their primary care physician. Qualified professionals (RRTs and/or RPSGTs) completed Level III instruction and review of results (interpreted by a Board Certified Sleep Physician). If PAP therapy was prescribed, the patient was given a one month, Auto-CPAP (APAP) trial. During this APAP trial, patients were closely followed by a sleep clinician. At the start of the APAP trial, all patients were put on a wireless modem. This was done to monitor overall compliance and how the patient was doing on therapy. Each patient was given a phone call within 1–3 days of starting therapy. They were also scheduled and seen in office for a one month follow-up visit. If there were any problems that could not be addressed over the phone or via the modem, an office visit was scheduled in between this time. At the end of the APAP trial, patients were then scheduled to be seen again one month after they purchased. At this time, they were then given a 6 month follow-up phone call as well as a scheduled annual office visit the following year. At all office visits, the compliance card from the APAP machine was downloaded to obtain average hourly usage including compliance, the Apnea Hypopnea Index (AHI), and leak. The Epworth sleepiness scale (ESS) was also completed by the patient to assess their degree of sleepiness in comparison to their previous visit. Results The results revealed that there were 73 female and 225 male patients ( N  = 298) that met inclusion criteria. There were 275/298 (92.3%) patients that completed their one month PAP trial. At the end of the one month therapy trial visit, patients showed continued therapy use for an average of 5.40 h a night for 93.0% of the time. At the one month post purchase visit, patients showed continued therapy use for an average of 6.51 h a night for 97.0% of the time. After one year, there were 201/275 (73.9%) patients (76 female and 125 male) still on PAP therapy. Conclusion The preliminary results revealed that with close follow-up for APAP/CPAP patients, it is possible to obtain successful compliance of a minimum of 4 h/night, 70% of the time over a 30 day period. Our compliance for the 201 patients on APAP/CPAP after one year of PAP therapy was 6.33 h a night for 94.0% of the time. Acknowledgements All sleep staff at Respiratory Homecare Solutions – Calgary.