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. 2023 Mar 1;19(3):573-579.
doi: 10.5664/jcsm.10390.

Nasal polyposis is a risk factor for nonadherence to CPAP treatment in sleep apnea: the population-based DISCOVERY study

Caroline Bengtsson  1 , Ludger Grote  2   3 , Mirjam Ljunggren  4 , Magnus Ekström  5 , Andreas Palm  4   6
Affiliations

Nasal polyposis is a risk factor for nonadherence to CPAP treatment in sleep apnea: the population-based DISCOVERY study

Caroline Bengtsson et al. J Clin Sleep Med. .

Abstract

Study objectives: The aim was to evaluate nasal polyposis as a risk factor for nonadherence to continuous positive airway pressure (CPAP) treatment in patients with obstructive sleep apnea (OSA).

Methods: This was a population-based, longitudinal analysis of patients starting CPAP treatment for OSA in the Swedish quality registry Swedevox between 2010 and 2018. Data were cross-linked with national registries. The impact of nasal polyposis on CPAP adherence was analyzed using uni- and multivariable logistic and linear regression models. Relevant confounders (age, sex, usage of nasal and oral steroids) were identified using a direct acyclic graph.

Results: Of 20,521 patients with OSA on CPAP treatment (29.5% females), 331 (1.6%) had a diagnosis of nasal polyposis at baseline. At the 1-year follow-up, nasal polyposis was associated with an increased risk of CPAP usage < 4 hours/night (unadjusted odds ratio [OR] 1.21; 95% confidence interval [CI] 0.95-1.55); adjusted OR 1.38; 95% CI 1.08-1.77). In this group, unadjusted nocturnal mean CPAP usage was 15.4 minutes (95% CI -31.62 to 0.83) shorter and was an adjusted 24.1 minutes (95% CI -40.6 to -7.7) shorter compared with patients with OSA without nasal polyposis.

Conclusions: Nasal polyposis is associated with reduced CPAP usage per night. These results highlight the importance of diagnosing nasal polyposis in patients with OSA before the start of CPAP treatment. Treatment of the condition may improve adherence, efficacy, and patient outcomes.

Citation: Bengtsson C, Grote L, Ljunggren M, Ekström M, Palm A. Nasal polyposis is a risk factor for nonadherence to CPAP treatment in sleep apnea: the population-based DISCOVERY study. J Clin Sleep Med. 2023;19(3):573-579.

Keywords: CPAP; adherence; nasal obstruction; nasal polyposis; population-based.

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Conflict of interest statement

All authors have seen and approved the manuscript. Work for this study was performed at the Department of Surgical Sciences, Otorhinolaryngology, Head and Neck Surgery, Uppsala University; Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University; and Centre for Research and Development, Region of Gävleborg/Uppsala University, Gävle Hospital. Caroline Bengtsson was supported by the Bror Hjerpstedt’s Foundation. Andreas Palm was supported by the Swedish Society for Sleep Research and Sleep Medicine, Uppsala-Örebro Regional Research Council (log number RFR-931234); Centre for Research and Development, Uppsala University/Region Gävleborg (log number CFUG-925881); Bror Hjerpstedt’s Foundation, Uppsala County Association against Heart and Lung Diseases; and the Fagerström Foundation. Ludger Grote was supported by the Swedish Heart and Lung Foundation (number 2018-567) and the agreement concerning research and education of doctors (ALFGBG-725601). Magnus Ekström was supported by unrestricted grants from the Swedish Society for Medical Research and the Swedish Research Council (log number 2019-02081). The sponsors had no roles in study design, data collection, data analysis, data interpretation, or writing of the report. Outside the submitted work, Ludger Grote reports nonfinancial research support from Itamar Medical and Resmed, research grant and clinical trial support from Desitin, and speaker bureau activities for Itamar Medical, Resmed, Philips, AstraZeneca, and Breas. In addition, Ludger Grote reports ownership in a licensed patent on sleep apnea therapy. The authors report no conflicts of interest.

Figures

Figure 1
Figure 1. Flowchart of the study population.
CPAP = continuous positive airway pressure.
Figure 2
Figure 2. Direct acyclic graph (DAG).
Red dots indicate the minimal sufficient adjustment set for estimating the total effect of nasal polyposis on adherence to CPAP. Green arrows: causal path. Red arrows: biasing path. AHI = apnea-hypopnea index, BMI = body mass index, CPAP = continuous positive airway pressure, ESS = Epworth Sleepiness Scale.
See this image and copyright information in PMC

References

    1. Gay P , Weaver T , Loube D , Iber C ; Positive Airway Pressure Task ForceStandards of Practice CommitteeAmerican Academy of Sleep Medicine . Evaluation of positive airway pressure treatment for sleep related breathing disorders in adults . Sleep. 2006. ; 29 ( 3 ): 381 – 401 . - PubMed
    1. Weaver TE , Grunstein RR . Adherence to continuous positive airway pressure therapy: the challenge to effective treatment . Proc Am Thorac Soc. 2008. ; 5 ( 2 ): 173 – 178 . - PMC - PubMed
    1. Palm A , Grote L , Theorell-Haglöw J , et al. . Socioeconomic factors and adherence to CPAP—the population-based DISCOVERY study . Chest. 2021. ; 160 ( 4 ): 1481 – 1491 . - PMC - PubMed
    1. Bengtsson C , Jonsson L , Theorell-Haglow J , Holmstrom M , Janson C , Lindberg E . Sinonasal outcome test-22 and peak nasal inspiratory flow - valuable tools in obstructive sleep apnoea . Rhinology. 2020. ; 58 ( 4 ): 341 – 348 . - PubMed
    1. Sugiura T , Noda A , Nakata S , et al. . Influence of nasal resistance on initial acceptance of continuous positive airway pressure in treatment for obstructive sleep apnea syndrome . Respiration. 2007. ; 74 ( 1 ): 56 – 60 . - PubMed