Study of factors affecting compliance of continuous positive airway pressure (CPAP) in obstructive sleep apnea-hypopnea syndrome (OSAHS)

Abstract

Background: Poor adherence (30-60%) to CPAP is a recognized limiting factor in treating OSAHS, leaving patients at risk for co-morbid conditions and impaired quality of life. Aims and Objectives: To study patient9s compliance to CPAP in OSAHS, evaluate effect of regular follow-up on compliance and establish causes for noncompliance. Method: 42 patients with OSAHS on polysomnography and symptoms of excessive daytime sleepiness were randomised in 2 equal groups. All were counseled on CPAP initiation. Follow up was at regular intervals over six months in group 1 and directly at end of 6 months in group 2. The groups were compared for a co-relation between frequency of follow up and CPAP compliance. Effect of age, sex, AHI, Epworth Sleepiness Scale (ESS) Score, hours of first night use of CPAP and type of CPAP machine was also studied. Results: Good compliance to CPAP was seen in 52% and poor compliance in 48%. Regular follow up had no statistically significant change in compliance amongst the group 1 patients. Epworth Sleepiness Scale (ESS) Score >12 [p 4 hours [p=0.003] and usage of auto CPAP unit [p=0.007] were statistically significant predictors of compliance. No significance was established with factors like age, gender and AHI. Causes of poor compliance were, mask related (60%), patient related (25%) and machine related (15%). Conclusion: Counseling at CPAP initiation is important in improving long term CPAP compliance. Addressing factors like mask size, fitting or type of machine on CPAP initiation itself will increase adherence to CPAP therapy and may obviate the need for frequent follow up.