PT - JOURNAL ARTICLE AU - Hanna-Riikka Kreivi AU - Paula Maasilta AU - Adel Bachour TI - Persistence of Upper-Airway Symptoms During CPAP Compromises Adherence at 1 Year AID - 10.4187/respcare.04113 DP - 2016 May 01 TA - Respiratory Care PG - 652--657 VI - 61 IP - 5 4099 - http://rc.rcjournal.com/content/61/5/652.short 4100 - http://rc.rcjournal.com/content/61/5/652.full AB - BACKGROUND: The most common adverse effects of CPAP are related to the upper airways. We evaluated upper-airway symptoms before and after a CPAP trial as well as their effect on CPAP adherence. We also evaluated the effect of humidification added to CPAP therapy on upper-airway symptoms.METHODS: We followed for 1 y 536 subjects with obstructive sleep apnea scheduled consecutively for CPAP initiation. Subjects completed visual analog questionnaires on nasal stuffiness, rhinorrhea, and mouth dryness (0 = no symptoms, 100 = severe symptoms).RESULTS: Before CPAP initiation, mean nasal stuffiness score was 29.6 ± 24.9, rhinorrhea score was 16.0 ± 21.7, and mouth dryness score was 43.8 ± 33.1. In subjects who quit CPAP treatment before the 1-y follow-up, the increase in rhinorrhea score during CPAP initiation was significant, 5.3 (95% CI 0.5–9.5, P = .02), and in those using CPAP at 1 y, nasal stuffiness score and mouth dryness score decreased significantly during initiation, −5.1 (95% CI −7.9 to −2.4, P < .001) and −21.2 (−25.5 to −17.4, P < .001). Mouth dryness score decreased significantly with CPAP regardless of humidification: change with humidification, −18.1 (95% CI −22.1 to −14.3), P < .001; change without, −10.5 (95% CI −16.9 to −4.1), P = .002. Humidification also prevented the aggravation of rhinorrhea (change, −0.4 [95% CI −2.6 to 1.9], P = .75) and alleviated nasal stuffiness (change −5.3 [95% CI −7.8 to −2.6], P < .001) with CPAP, whereas its absence induced a significant rise in symptom scores: change in rhinorrhea, 11.5 (95% CI 7.1–16.7), P < .001; change in nasal stuffiness, 8.5 (95% CI 3.9–13.5, P < .001).CONCLUSIONS: The severity of upper-airway symptoms before CPAP does not predict CPAP use at 1 y, whereas CPAP non-users at 1 y had smaller or no alleviation in symptom scores during initiation compared with those who continued CPAP treatment.