Long-term Compliance with Nasal Continuous Positive Airway Pressure Therapy: RESULTS

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The baseline characteristics of the 96 long-term home nasal CPAP patients are displayed in Table 1. Eighty percent complained of severe daytime sleepi­ness and 20 (21 percent) had undergone previous uvulopalatopharyngoplasty (UPPP) that was unsuc­cessful. The patients were predominantly male and obese (114.7 ±30 kg, mean±SD). All patients had significant OSA with sleep disruption and nocturnal hypoxemia. Table 2 shows the AHI, sleep staging, and minimum Sa0₂ in the entire group at baseline and during nasal CPAE Nasal CPAP clearly reduced the sleep-disordered breathing, improved nocturnal Sa0₂, and increased the percentage of stage 3 plus 4 and REM sleep.

FIGURE 1. Sleep-disordered breathing at baseline and with nasal CPAP

Nineteen patients with OSA who agreed to a nasal CPAP trial were never treated with home nasal CPAE Seven of these patients were unable to sleep with nasal CPAP Four patients tolerated one night in the sleep laboratory but refused home therapy. Eight patients were unable to complete a one-night nasal CPAP trial. These 19 patients were compared with the compliant and noncompliant groups by analysis of variance for the following variables: age, weight, AHI, and minimum Sa0₂ on presentation. No significant differences were detected. Two of the 19 patients who refused home CPAP had previous UPPP The overall frequency of patients with UPPP refusing home ther­apy (two of 22) was not significantly different than the frequency of those refusing home CPAP in the group without prior UPPP (17 of 103).  viagra soft

FIGURE 2. Sleep stages—baseline and with nasal CPAP.

Table 1—Characteristics of Patients Receiving Long-term Home Nasal CPAP (n = 96)

Characteristic
Age, у	48.7 ±12.8*
Sex	81 M, 15 F
Weight, kg	114.7 ±30*
Severe daytime sleepiness, No. (%)	77(80)
Previous palatal surgery, No. (%)	20(21)
Baseline apnea plus hypopnea index	57.2 ±26.9*
Baseline minimum Sa02	69.1 ±10.3*

Twenty-three (24 percent) of the 96 patients receiv­ing home nasal CPAP therapy had discontinued ther­apy at the time of the follow-up questionnaire in November 1987. Seventy-three patients (76 percent) continued to receive nasal CPAP therapy for 14.5±10.7 months (mean±SD). Including the 19 patients who refused a home nasal CPAP trial or did not tolerate one night of nasal CPAP therapy in the laboratory, the overall compliance rate drops to 63 percent. Table 3 compares the baseline characteristics of the compliant and the noncompliant groups. There were no significant differences in age, sex distribution, or weight between the two groups. Previous UPPP was more frequent in the noncompliant patients than in the compliant group (p<0.05, Fishers exact test). Severe daytime sleepiness prior to therapy was a more frequent symptom in the compliant group (p<0.001, Fishers exact test). Severe daytime sleepiness was eliminated by nasal CPAP therapy in all the compliant patients and all but one of the noncompliant patients. levitra professional

Table 2—Sleep Data: Long-term Nasal CPAP (n=96)

	Baseline*	CPAP*
Apnea plus hypopnea indexf	57.2 ±26.9	2.2±4.2
Stage 1 + 2 sleep, %	70.4 ±18.4	40.1 ±16.8
Stage 3+4 sleep, %	17.8 ±17.1	38.9± 13.0
REM sleep, %	11.9±6.7	21.0± 11.0
Minimum SaOs, %	69.1 ±10.3	88.6±8.4

There were no significant differences in the severity of sleep apnea or the effectiveness of nasal CPAP in the compliant and noncompliant groups (Fig 1). The AHI and minimum Sa0₂ improved dramatically in both groups with nasal CPAP therapy. Sleep-staging data for compliant and noncompliant patients are presented in Figure 2. There was a small but signifi­cantly higher percentage of stage 1 plus 2 sleep in the noncompliant group. Both groups had markedly re­duced stage 1 plus 2 and increased stage 3 plus 4 and REM sleep after nasal CPAP therapy (p<0.05).

Table 3—Compliant and Noncompliant Patients Receiving Nasal CPAP

Compliant (n = 73)	Noncompliant (n = 23)
Age, yr 48 ±17.8* Sex 61 M, 12 F Weight, kg 115.8 ±29.8* Severe daytime sleepiness,t No. (%) 65 (89) Previous palatal surgery,! No. (%) 10 (14)	49.5 ±15.8* 20 M, 3 F 116.9 ±35.5* 12(52) 10(43)