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Obstructive sleep apnea (OSA) is a chronic disease treated effectively with the use of continuous positive airway pressure (CPAP) therapy. Patient adherence to prescribed CPAP is variable, however, leaving the undertreated OSA patient at risk of development or worsening of comorbid medical conditions, including hypertension and cardiovascular disease. The severity of disease and the presence of daytime sleepiness appear to have some predictive quality for subsequent adherence, though a search for consistent predictive factors related to CPAP adherence has proven elusive. Other influences, such as sex, age, socioeconomic status, and personality traits are less robust predictors. The use of sophisticated therapy modalities such as auto-titration or bi-level PAP units has been shown to improve adherence in certain subsets of OSA patients. Adverse effects such as nasal congestion, dry mouth, or skin irritation occur in approximately 50% of CPAP users, and addressing these adverse effects may improve adherence in some patients. More encouraging, studies on the use of intensive patient education and behavioral interventions have shown more positive effects on adherence, leading to the conclusion that improvement in patient adherence to CPAP therapy requires a multi-layered approach, using combined technological, behavioral, and adverse-effect interventions.
- obstructive sleep apnea
- continuous positive airway pressure
- patient education
- behavioral interventions
- Correspondence: Suzanne M Bollig, RRT RPSGT REEGT, Hays Medical Center—Sleep and Neurodiagnostic Institute, 2500 Canterbury Drive, Suite 108, Hays KS 67601. E-mail: .
Ms Bollig presented a version of this paper at the 45th Respiratory Care Journal Conference, “Sleep Disorders: Diagnosis and Treatment” held December 10-12, 2009, in San Antonio, Texas. The author has disclosed no conflicts of interest.
↵* Pamela Minkley RRT RPSGT CPFT, Home Healthcare Solutions, Philips Respironics, Monroeville, Pennsylvania.
↵† Mark D'Angelo, Sleep Therapy, Philips Respironics, Monroeville, Pennsylvania.
↵‡ David J Pierson MD FAARC, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Harborview Medical Center, University of Washington, Seattle, Washington.
- Copyright © 2010 by Daedalus Enterprises Inc.