LONG-TERM ADHERENCE TO POSITIVE AIRWAY PRESSURE THERAPY IN PATIENTS WITH OBSTRUCTIVE SLEEP APNEA AND CARDIOVASCULAR DISEASES

Abstract

Objective: to study long-term (more than 12 months) adherence to positive airway pressure (PAP) therapy and its effectiveness in OSA patients with arterial hypertension (AH) and to determine possible factors influencing adherence to PAP therapy Design and method: The study involved 194 patients with OSA and AH (156 men and 38 women), median age 64 [55; 69] years, who were on PAP therapy for more than 12 months. Patients had severe OSA (apnea-hypopnea index (AHI) - 49 [35,6; 63,2] events/h. The duration of the PAP-therapy usage - 2,0 years [1,0; 5,0]. Data from PAP therapy for the last year was downloaded from the device’s internal memory card, including effectiveness and adherence. The adherence criteria was the usage of PAP therapy for more than 4 hours per night for more than 70% of nights, effectiveness - residual AHI less than 5 events per hour. The main parameters of the disease and PAP-therapy were analyzed depending on the adherence to therapy. Results: All patients used PAP-therapy in auto regime with constant use of a humidifier. Average time of long-term PAP-therapy usage was 6,2 hours [4,8; 7,3] and 84,6% [61,2; 97,0] of nights. The criteria for adherence to PAP - therapy was met in 64,9% of patients. The residual AHI was 3,0 events/h [1,3; 6,0]. When comparing the clinical parameters of PAP-therapy, it was found that in the group of adherent patients, residual AHI was statistically significantly lower: 2,4 events/h [1,2; 5,0] versus 4,0 events/h [2,0; 6,4], p < 0,05. Usage of PAP therapy less than 70% of nights and less than 4 hours per night statistically significantly more often complained of daytime sleepiness (44%) and nocturia (19%) versus 24% and 8% respectively in the compared group. Adherent patients were statistically significantly more likely to use nasal masks in 81,7% of cases, compared with 64,7% of patients in the low-adherence group, p < 0,05. Conclusions: In patients with OSA and AH, 64,9% of patients meet the criteria for adherence to long-term PAP therapy. Residual daytime sleepiness and nocturia during prolonged PAP therapy are associated with low adherence.