Airway Pressure in Patients

COMMENT ON POST 1

Continuous positive airway pressure (CPAP) is an efficacious treatment for obstructive sleep apnea (OSA). Even though many OSA patients get significant benefits from CPAP, adherence, and compliance remain challenging for these patients. Just an example, in a study regarding the adherence of CPAP conducted by Wolkove et al., for the 80 patients who had been seen four years previously at Mount Sinai Hospital Clinic (Montreal, Qubec), showed that only 54% were still using CPAP, 15% stopped using CPAP and 31% never filled the prescription.

Some of the side effects CPAP users mentioned in this study are non-acceptance of CPAP device, lack of a positive perspective regarding the benefit of CPAP therapy, intolerance of positive pressure, poor self-efficacy, discomfort with the device, a sense of claustrophobia with the mask, anxiety, inconvenience, frequent nocturnal awakening, and CPAP affecting partner’s sleep complaints. Some CPAP users abandon the use due to nasal discomfort and airway dryness.

Now the question arises what’s the best approach to help these non-compliant patients? An integrated approach with the combination of behavioral therapy that includes cognitive-behavioral therapy (CBT) and motivational enhancement therapy (MET) plus education and prompt management of side effects might encourage these patients to use CPAP therapy. For example, CPAP users who encounter uneasiness on the face, pressure ulcers on cheeks and nose, and air leaks might have an ill-fitting mask. It is vital to spend a good amount of time educating these patients regarding the pressure of the machine and the efficacy of a good seal for a better outcome (Weaver, & Grunstein, 2008).

Again, to answer the question of patients who stick to long-term therapy, Wolkove et al., study showed slightly more than one-half of the patients, i.e., 43 (54%) patients out of 80 remained compliant and highly satisfied with the treatment at long-term follow up (Wolkove et al., 2008).

Respironics recall has interrupted the life of these compliant CPAP users completely. After a comprehensive PSG study and trials, these patients found the perfect device to have improved and better sleep. Now, this recall has again created anxiousness, uneasiness, and questioning the trust and safety of these progressive devices. At the hospital I work, we were using REM star machine for these patients. After the recall, we are using V60 machines, which have a limited number in terms of availability plus cost. Sometimes we get into this ethical dilemma to put the device on the most needed patient. I am just wishing and hoping for a good solution from Respironics in the near future.

References

 

Weaver, T. E., & Grunstein, R. R. (2008). Adherence to continous positive airway pressure therapy. American Thoracic society, 15(5). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2645251/ (Links to an external site.)

 

Wolkove, N., Baltzan, M., Kamel, H., Dabrusin, R., & Palayew, M. (2008). Long-term compliance with continuous positive airway pressure in patients with obstructive sleep apnea. Canadian Respiratory Journal. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2679572/    For more information on airway pressure in patients check on this:

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