Long-term compliance with continuous positive airway pressure in Saudi patients with obstructive sleep apnea. A prospective cohort study

Abstract

Objectives: To evaluate continuous positive airway pressure (CPAP) compliance and define predictors of CPAP compliance among Saudi patients with obstructive sleep apnea (OSA) after applying an educational program.

Methods: This prospective cohort study included consecutive patients diagnosed to have OSA based on polysomnography between January 2012 and January 2014 in King Saud University, Riyadh, Kingdom of Saudi Arabia. All patients had educational sessions on OSA and CPAP therapy before sleep study, and formal hands-on training on CPAP machines on day one, day 7, and day 14 after diagnosis. The follow-up in the clinic was carried out at one, 4, and 10 months after initiating CPAP therapy. Continuous positive airway pressure compliance was assessed objectively. Logistic regression model was used to assess the predictors of CPAP adherence.

Results: The study comprised 156 patients with a mean age of 51.9±12.1 years, body mass index of 38.4±10.6 kg/m2, and apnea hypopnea index of 63.7±39.3 events/hour. All patients were using CPAP at month one, 89.7% at month 4, and 83% at month 10. The persistence of CPAP-related side effects and comorbid bronchial asthma remained as independent predictors of CPAP compliance at the end of the study.

Conclusion: With intensive education, support, and close monitoring, more than 80% of Saudi patients with OSA continued to use CPAP after 10 months of initiating CPAP therapy.

Figure 1

Study protocol of patients who underwent 2 level I in-lab sleep studies. CPAP - ontinuous positive airway pressure, OSA - obstructive sleep apnea, PSG - polysomnography

Figure 2

Continuous positive airway pressure (CPAP) compliance at one, 4 and 10 months. The comparisons revealed that: A) CPAP compliance (%) at one, 4, ad 10 months p-value was <0.05 based on Friedman analysis (over all group difference). When pair-wise comparisons were made between different pairs using paired sample Wilcoxon test, the difference was statistically different (p-value<0.05). B) Percentage of days during which CPAP was used. C) Average hours of CPAP usage (hour/day).