Chest
Volume 103, Issue 6, June 1993, Pages 1675-1680
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Clinical Investigations
Self-Reported vs Measured Compliance with Nasal CPAP for Obstructive Sleep Apnea

https://doi.org/10.1378/chest.103.6.1675Get rights and content

To estimate reliability of self-reported compliance with nasal continuous positive airway pressure (CPAP) therapy for obstructive sleep apnea (OSA), we studied 63 OSA patients aged 53.7 ± 1.2 years (mean ± SEM) with an apnea hypopnea index (AHI) of 50.8 ± 2.9 and lowest sleep SaO2 of 65.6 ± 2.3 percent receiving nasal CPAP for 539 ± 44 days. During a follow-up polysomnography (PSG) on the pressure prescribed for home therapy (10.3 ± 0.3 cm H2O), the hours of operation shown on the built-in time counter of the patients' devices were read to determine objective compliance by dividing the run time by the days since initiation of therapy. This parameter was compared with subjective compliance reported in a self-administered questionnaire. Mean measured use time was 4.9 ± 0.3 h per night, whereas reported daily use time calculated from reported nights a week and hours a night was 6.1 ± 0.3 h per night. As predominantly patients with poor compliance misestimated daily use time, we conclude that self-reports are unable to distinguish between compliant and noncompliant patients.

(Chest 1993; 103:1675-80)

Section snippets

Patients

We included 63 consecutive OSA patients (55 male, 8 female) prescribed nasal CPAP for a minimum of 3 months. At the time of the study, they were receiving nasal CPAP for 18 ± 1 months, with a wide range from 4 to 42 months. Mean age of our study population was 53.7 ± 1.2 years. During the initial study, apnea hypopnea index (AHI) was 50.8 ± 2.9, and lowest oxyhemoglobin saturation (SaO2) was 65.6 ± 2.3 percent. Our subjects were moderately obese (body mass index [BMI] baseline: 32.3 ± 0.8) and

RESULTS

The frequency distribution of measured use times per night in our patients is given in Figure 1. As Um was above 4 h a night in 45 of our 63 patients, we found long-term compliance with nasal CPAP of 71 percent for a mean treatment period of 18 months. Mean measured time of use was 4.9 ± 0.3 h per night, with a wide range from 0.2 to 8.3. In contrast, our patients reported to use their CPAP device for 6.3 ± 0.2 nights a week and 6.5 ± 0.2 h a night, which theoretically would equal a mean use

DISCUSSION

Despite significant correlations between measured and reported times of CPAP use per night, self-reports turned out to be an inaccurate tool to determine compliance with nasal CPAP therapy for OSA. Trying to estimate daily use time by simply asking how many hours a night the patient uses the device generally results in a considerable misestimation of actual mean treatment time per night because the patient is likely to provide the number of hours of CPAP use solely for the nights it was worn.

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    Manuscript received July 9; revision accepted October 7.

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