Long-term compliance with CPAP therapy in patients with obstructive sleep apnea and hypertension
M.V. Gorbunova, S.L. Babak, A.G. Malyavin
A.I. Evdokimov Moscow State University of Medicine and Dentistry, Department of Phthisiology and Pulmonology, Moscow
Background. Therapy with CPAP therapy (Continuous Positive Airway Pressure or CPAP therapy) is a fundamental therapeutic doctrine in patients with obstructive sleep apnea (OSA). However, the compliance of patients with OSA to CPAP therapy significantly depends on comorbid conditions and is poorly predictable and poorly understood during its long-term administration.
Objective. The aim of the study was to investigate the compliance of patients with OSA to long-term (one-year) CPAP therapy with the function of auto-adaptation to the patient’s inhalation and exhalation (A-Flex therapy).
Methods. To the prospective study were included 310 patients with OSA (273 male, 45,3±10,4 yr.) with apnea-hypopnea index (AHI) >5 events /hour. The night polygraphy study (PG) was performed to calculate AHI, oxygen desaturation index (ODI), mean nocturnal saturation (SpO2) by the rules of American Academy of Sleep Medicine (AASM). The target level of CPAP therapy was titrated at home. Compliance criteria markers were represent by indexes of using therapy (PDU, AU, PDU≥4, PDU <4), therapeutic pressure levels (CMP, CPP), index of air leakage (LDU), value of corrected AHI (AHIcpap), assessed by original program of compliance analysis Encore Pro v.2.14 (Philips Respironics, USA).
Results. Positive compliance dynamic to CPAP occurs after 6 months of therapy: PDU≥4 increase by + 5.21% (95% Cl from 3.70 to 6.23; p=0.061), CMP decrease by – 1.32 mbar (95% Cl from -2.1 to -0.86; p=0.082), LDU decrease by -4.30% (95% Cl from -6.71 to -2.91; p=0.031) in the group of mild OSA patients. After 3 months of A-Flex therapy we found a significant increase PDU≥4 by +16,20% (95% Cl from 13,20 to 18,61; p=0,001), decrease CMP by -2,31 mbar (95% Cl from -3,6 to -1,91; p=0,001), decrease LDU by -4,41% (95% Cl from -7,21 to -3,75; p=0,01) in moderate OSA patients. After 6 months of A-Flex therapy we found a significant increase PDU≥4 by +17,91%
(95% Cl from 15,80 to 21,11; p=0,001), decrease CMP by -3,31 mbar (95% Cl from -4,1 to -2,91; p=0,001), decrease LDU by -10,69% (95% Cl from -13,25 to -8,41; p=0,001) in severe OSA patients.
Conclusions. The high compliance of patients with long-term targeted CPAP therapy, especially in the group of moderate to severe OSA, reliably depends on its effectiveness and the choice of interface that allows for the regular repeatability of the procedure on each therapeutic night.
Keywords: compliance to therapy, obstructive sleep apnea, arterial hypertension, CPAP therapy, A-Flex therapy
About the Autors
Corresponding author: Sergey L. Babak, MD, Professor at the Department of Phthisiology and Pulmonology, A.I. Evdokimov Moscow State University of Medicine and Dentistry, Moscow; e-mail: firstname.lastname@example.org
Address: 20, Build. 1, Delegatskaya Street, Moscow 127473, Russian Federation