PREDICTIVE FACTORS OF LONG-TERM COMPLIANCE WITH NASAL CONTINUOUS POSITIVE AIRWAY PRESSURE TREATMENT IN SLEEP-APNEA SYNDROME

The long-term acceptability of treatment with nasal continuous positiv e airway pressure (CPAP) was studied prospectively in 44 patients with obstructive sleep apnea syndrome. At 14 months on the average after s tarting treatment with CPAP, 30 patients (68 percent) were found to be compliant (characterized by use of the apparatus every night througho ut the night, for more than 5 h per night). The daily use of nasal CPA P was significantly correlated to the initial apnea/hypopnea index (p = 0.013; r = 0.37), as well as to the percentage of light sleep (p = 0 .045; r = 0.30) and slow-wave sleep (p = 0.037; r = - 0.31) during the initial polygraphic recording. We found a strong correlation between the daily use of nasal CPAP and the difference in the apnea/hypopnea i ndex (p = 0.025; r = - 0.34), the difference in mean oxygen saturation during sleep (p = 0.013; r = 0.38), and the difference in hypersomnia scores (p = 0.006; r = - 0.40) obtained before and after treatment by nasal CPAP. Thus, patients used CPAP much more if they had an initial significant clinical handicap and if they were aware of the beneficia l effects of CPAP. Under these conditions, patients tended to use the apparatus for the optimal length of time, regardless of the side effec ts linked to the treatment. This ensured efficacy and the maintenance of good compliance. This study confirms the importance of supervision of the time counter, as well as regular encouragement of patients to u se the treatment as long as possible each night, in order to extract a maximum benefit from treatment by nasal CPAP.