While it is probably acceptable to take extreme values at face value, whether low or very high, the imprecision of the methodology makes it more difficult to reliably use middling values in a clinical setting. (Schwab et al. Am J Respir Crit Care Med. 2013;188[5]:613). If a patient remains symptomatic despite no evidence of residual respiratory events from the adherence data download, a retitration study should still be considered.
Educational programs
Adherence to CPAP has been shown to increase when providers engage patients in educational programs to enhance compliance and understanding of the potential health-care consequences of untreated OSA (Lai et al. Chest. 2014 May 8. doi: 10.1378/ chest.13-2228. [Epub ahead of print]).
Early education and continuous support provide reinforcement of the need for adherence to therapy, as well as an opportunity to personalize the treatment and adjust settings and equipment as needed for each individual patient. Although specific guidelines for the best timing of the educational intervention are still lacking, evidence suggests that long-term compliance with CPAP might be determined as early as 2 weeks after therapy is initiated (Aloia et al. J Clin Sleep Med. 2005;1[4]:346). Therefore, educational programs should be readily available for prospective and new CPAP users in order to enhance their understanding of OSA and knowledge about CPAP treatment and to provide them with a venue for reviewing and managing compliance-related issues. Such programs can be run by dedicated sleep technologists, respiratory therapists, or nurses in clinics where physician availability is more limited.
Summary
CPAP remains the most effective treatment for OSA, though adherence is a struggle for many patients. Identifying the best mask for a given patient, determining whether humidification or an expiratory pressure drop should be added and making early and frequent contact after prescription can all assist in improving long-term CPAP use. Regular review of adherence data with the patient is also important, modifying the therapy as necessary to optimize comfort, understanding that such changes may necessitate a subsequent pressure adjustment to maintain disease control.
Implementing a comprehensive approach to managing patients using CPAP therapy can impact compliance by reducing treatment-related complaints and improving comfort.
Dr. Ebben is Assistant Professor of Psychology in Clinical Neurology, Department of Neurology; and Dr. Krieger is Associate Clinical Professor, Departments of Medicine, Neurology, and Genetic Medicine; Weill Cornell Medical College of Cornell University, New York, New York.