TREATMENT OF PATIENTS WITH THE OBSTRUCTIVE SLEEP-APNEA SYNDROME (OSAS) USING NASAL CONTINUOUS POSITIVE AIRWAY PRESSURE (NCPAP) .1. LONG-TERM COMPLIANCE WITH NCPAP

Background: Nocturnal ventilation with nCPAP has been established as t he safest and most efficient nonsurgical treatment for OSAS. Long-term results, however, are determined by the patients' compliance with the rapy. The aim of this study was the objective measurement of long-term acceptability of nCPAP therapy in all patients receiving this treatme nt in our sleep laboratory between January 1990 and March 1995. Method s: We prospectively investigated 41 patients (36 male, 5 female) with moderate to severe OSAS who received nCPAP therapy. Mean time of follo w-up was 20.6 months, ranging from 1.2 to 53.5 months. Therapy was ind icated when OSAS was confirmed by cardiorespiratory polygraphy and eit her (1) the patient complained of daytime sleepiness or (2) the patien t possessed an apnea-hypopnea index greater than 30/h or when the mean oxygen desaturation was below 80% regardless of the presenting sympto ms. The compliance with treatment was defined as a mean rate of use of over 5 hours per night calculated from the time counter on the nCPAP machine. Results: 33 patients (88.5%) have continued using nCPAP until the present time but only 24 patients (59%) met our criteria for long -term acceptance and this group was identified as responders. We found no significant differences in age, body mass index, apnea-hypopnea in dex, and nCPAP-pressure between responders and non-responders. Conclus ion: Although nCPAP is the safest treatment for OSAS, there is still a large group of patients with moderate to severe OSAS who are not effi ciently treated with nCPAP because of the low long-term acceptability of this therapy. With respect to this group of patients, surgical appr oaches have to be considered as an alternative therapy.