Obstructive sleep apnea affects around 20 million Americans and can lead to hypertension, heart attack, stroke, depression, muscle pain, fibromyalgia, morning headaches, and excessive daytime sleepiness.

Wednesday, September 1, 2010

Respiratory Care Article Details Problems with CPAP Adherence.

The Respiratory Journal looks at problems related to CPAP adherence. The September 2010 article states "Adverse effects such as nasal congestion, dry mouth, or skin irritation occur in approximately 50% of CPAP users" These side effects are only a few of the problems patients experience that lead to CPAP non-compliance. There are many advances in CPAP treatment that have little effect for most patients on CPAP success. The article states "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" but other research shows little change in CPAP compliance rates. The problems associated with CPAP are the reasons so mmany patients exclaim "I HATE CPAP!".

What kind of patient does not do well with CPAP? The article further states " 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." In essence all types of patients in every category do not tolerate or adhere to CPAP treatment.

Cpap is a very effective treatment but it is not the best sleep apnea treatment for those patients who do not use it. A recent study showed 60% of patients abandon CPAP. In other words when compliance is factored in the majority of patients are not helped by CPAP'

Dental Sleep Medicine and Oral Appliances may be the best sleep apnea treatment for the majority of patients. Even though they may not be as effective as CPAP they are far more effective than no treatment.

Cardiologists recognize that "the undertreated OSA patient at risk of development or worsening of comorbid medical conditions, including hypertension and cardiovascular disease.". They are also aware of the poor compliance that plagues CPAP.

The concerned and informed cardiologists are now recognizing that CPAP is a dismal failure for the majority of sleep apnea patients and are starting to refer more patients for oral appliance therapy. When patients lives are at stake there must be alternatives to CPAP offered to the patients who do not tolerate CPAP. Regardless of the effectiveness of CPAP it is a worthless treatment if it is not used.

Dental Sleep Medicine offers life-changing alternatives to CPAP to cardiac patients who do not tolerate CPAP.

Respir Care. 2010 Sep;55(9):1230-9.
Encouraging CPAP Adherence: It Is Everyone's Job.
Bollig SM.

Hays Medical Center-Sleep and Neurodiagnostic Institute, 2500 Canterbury Drive, Suite 108, Hays KS 67601. suzanne.bollig@haysmed.com.
Abstract
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 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.

PMID: 20800003 [PubMed - in process]

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posted by Dr Shapira at 6:44 PM