MONTREAL -- The dismal compliance of sleep apnea patients with continuous positive airway pressure treatment could be significantly improved with simple measures such as education and support, according to several experts.
"We need to advise, educate, and empower these patients," said Dr. Philip Westbrook at the Eighth World Congress on Sleep Apnea. "They need to know how to treat their illness, they need the tools to monitor their treatment, and they need to be aware of the risks associated with their disease," he said.
A study presented elsewhere at the meeting showed that patients' 5% annual dropout rate from continuous positive airway pressure (CPAP) therapy was mostly the result of the equipment being noisy and cumbersome.
Out of the 221 patients who were initially prescribed CPAP, 35% refused treatment, and 41% of those who initiated treatment discontinued it over the 8-year follow-up.
"What's the use of having a thousand-dollar machine sitting in the closet when all it takes is a nurse or a respiratory technician to say the reason it's not working is because of the wrong mask or because the pressure is too high?" said Dr. T. Douglas Bradley, of the University of Toronto.
Dr. Bradley was principal investigator of the CANPAP trial, which studied the effects of CPAP on cardiovascular function and mortality in heart failure patients with central sleep apnea (N. Engl. J. Med. 2005;353:2025-33). The trial achieved an 85% CPAP compliance rate, partly because of "the zeal of the investigators," he said at the meeting.
"It's a question of how much energy you put into it," Dr. Bradley said in an interview. "It's one thing to say, 'Here's the CPAP machine, see you later.' But it's another thing to say, 'I'm going to see you in a week from now, I am going to phone you to make sure you're using it properly, I'm going to download your compliance, and I'm going to make you feel guilty if you don't use it.' If you do that, you get very good compliance."
Arming patients with information about their condition and its treatment can empower them to take responsibility for it, Dr. Bradley said, and that's the best recipe for compliance with therapy.
In addition to simple tools such as bathroom scales and blood pressure cuffs that allow patients to monitor their own progress, he also believes in more complex tools. "I can imagine a CPAP machine that gives the patient feedback. We have focused on systems that give the sleep specialist information on how the patient is doing, but then the patient has to learn from the sleep specialist."
Machines that provide patients with information about their average pressure, time on the machine, mask leakage, and their respiratory disturbance index for the past night or the past week will all encourage patient involvement, he suggested. Such machines also might allow patients to alter the pressure themselves.
Patients should be provided with vital information about the risks associated with their disease, in particular the potentially lethal effects of opioids, said Dr. Westbrook, who is retired from clinical practice and serves as chief medical officer for Advanced Brain Monitoring Inc., which markets a home-based diagnostic device for sleep apnea patients.
In addition, all physicians dealing with sleep apnea patients should be given details of both the diagnosis and treatment--and spouses should also have this information in case of an emergency, he added.
Patients should bring their CPAP machines to the hospital if they are being admitted, especially if they are scheduled for a procedure that involves general anesthesia, sedation, or pain relief medication, Dr. Westbrook said.
Patients also should be aware that alcohol, smoking, sleeping pills, being overweight, and sleeping at high altitudes can all worsen the effects of sleep apnea, and that the sleep deprivation resulting from their condition could make driving and operating machinery dangerous. And patients should be checked annually for diabetes and hypertension, both of which are more common in people who have sleep apnea, he explained.