Meral UYAR, Osman ELBEK, Nazan BAYRAM, Öner DİKENSOY, Nilüfer ÇİFÇİ, Nevhiz GÜNDOĞDU, Ahmet METE

Factors influencing compliance with continuous positive airway pressure ventilation in obstructive sleep apnea syndrome

Giriş: Pozitif basınçlı tedavi obstrüktif uyku apne sendromunda birinci basamak tedavi olarak bilinmekle birlikte uyum birçok faktörden etkilenmektedir. Biz bu çalışmada uyumu etkileyen muhtemel faktörleri değerlendirmeyi hedefledik. Materyal ve Metod: Haziran 2006-Haziran 2008 tarihleri arasında obstrüktif uyku apne sendromu tanısıyla pozitif basınçlı ventilasyon tedavisi 140 hastaya başlanmıştı. Bu hastalardan %77 (n= 108)sine telefonla ulaşılarak tedavi uyumu ile ilgili anket yapıldı. Hava yolu pasajı lateral kafa grafileriyle değerlendirildi. Bulgular: Ortalama yaş 52.2 ± 12.3 yıl idi. Hastaların %71 (n= 77)i cihazı temin etmişti. Cihazı temin eden ve etmeyenler arasında cinsiyet, yaş, medeni durum, eğitim seviyesi, semptomlar, eşlik eden hastalıklar ve sosyal güvenlik açısından fark yoktu (p> 0.05). İki grup arasında Epworth uykululuk ölçeği (ESS) ve apne hipopne indeksi (AHİ) de benzerdi. Günlük ortalama cihaz kullanımı 6.3 ± 2.3 saat idi. Cihaz kullanım uyumunun yaş, cinsiyet, eğitim düzeyi, eşlik eden hastalıklar, ESS skoru, AHİ, hava yolu pasaj ölçümleri, nemlendirici varlığı ve cihazla ilgili eğitim verilmesinden etkilenmediği tespit edildi (p> 0.05). Hasta (p= 0.057) ve yatak partnerinin (p= 0.001) cihazla ilgili memnuniyetinin cihaz uyumunu artırdığı tespit edildi. Sonuç: Obstrüktif uyku apne sendromunda hasta ve yatak partnerinin cihazla ilgili memnuniyetleri cihaz kullanımındaki uyumu artırıyor görünmekte olup, C2 vertebra düzeyi ve hava pasajının en dar yerinden alınan ölçümlerle uyum ilişkili görünmemektedir.

Obstrüktif uyku apne sendromunda sürekli pozitif hava yolu basıncı tedavisine uyumu etkileyen faktörler

Introduction: Positive pressure ventilation is considered first line therapy in obstructive sleep apnea syndrome however compliance is limited by various factors. We aimed to investigate possible factors influencing compliance. Materials and Methods: One hundred and forty patients were prescribed positive pressure ventilation for obstructive sleep apnea during June 2006-June 2008. Of these patients, 77% (n= 108) were reached by telephone and a questionnaire was administered regarding factors influencing treatment compliance. Airway passage was measured with C2 vertebrae level and narrowest airway passage on lateral skull radiographs. Results: The mean age was 52.2 ± 12.3 years. Seventy one percent (n= 77) of subjects obtained the prescribed device. There was no difference in sex, age, marital status, educational level, symptoms, co-morbid conditions, and social security coverage between the subjects who have received the prescribed devices and who have not (p> 0.05). No difference was detected between these two groups of patients in view of Epworth sleepiness scale (ESS) and apnea hypopnea index (AHI). Mean duration of device usage was 6.3 ± 2.3 hours. The device use compliance was not affected by any of the following factors: age, gender, level of education, co-morbid diseases, ESS score, AHI, airway passage measurements, application of humidification and education concerning the device (p> 0.05). Patient (p= 0.057) and bed partners (p= 0.001) satisfaction about the device yielded higher compliance rates. Conclusion: Factors influencing compliance rates in obstructive sleep apnea syndrome seems to be related to satisfaction about the device use however upper airway morphology measured with C2 vertebrae level and narrowest airway passage has no impact on treatment compliance.

PDF

___

1. Olson EJ, Park JG, Morgenthaler TI. Obstructive sleep apneahypopnea syndrome. Prim Care 2005; 32: 329-59.
2. Kokturk O, Ciftci TU, Mollarecep E, Ciftci B. Elevated C-reactive protein levels and increased cardiovascular risk in patients with obstructive sleep apnea syndrome. Int Heart J 2005; 46: 801-9.
3. Ballard RD, Gay PC, Strollo PJ. Interventions to improve compliance in sleep apnea patients previously non-compliant with continuous positive airway pressure. J Clin Sleep Med 2007; 3: 706-12.
4. Weaver TE. Adherence to positive airway pressure therapy. Curr Opin Pulm Med 2006; 12: 409-13.
5. Richards D, Bartlett DJ, Wong K, Malouff J, Grunstein RR. Increased adherence to CPAP with a group cognitive behavioral treatment intervention: a randomized trial. Sleep 2007; 30: 635-40.
6. American Academy of Sleep Medicine. Sleep related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. The report of an American Academy of Sleep Medicine Task force Sleep 1999; 22: 667-89.
7. Johns, MW. Measuring daytime sleepiness: The Epworth Sleepiness Scale. Sleep 1991; 14: 540-5.
8. Wolkove N, Baltzan M, Kamel H, Dabrusin R, Palayew M. Long term compliance with continuous positive airway pressure in patients with obstructive sleep apnea. Can Respir J 2008; 15: 365-9.
9. Doherty LS, Kiely JL, Lawless G, McNicholas WT. Impact of nasal continuous positive airway pressure therapy on the quality of life of bed partners with obstructive sleep apnea syndrome. Chest 2003; 124: 2209-14.
10. Virkkula P, Bachour A, Hytönen M, Malmberg H, Salmi T, Maasilta P. Patient- and partner reported symptoms, smoking, and nasal resistance in sleep disordered breathing. Chest 2005; 128: 2176-82.
11. Sharief I, Silva GE, Goodwin JL, Quan SF. Effect of sleep disordered breathing on the sleep of bed partners in the Sleep Heart Health Study. Sleep 2008; 31: 1449-56.
12. Kiely JL, McNicholas WT. Bed partners assessment of nasal continuous positive airway pressure therapy in obstructive sleep apnea. Chest 1997; 111: 1261-5.
13. Breugelmans JG, Ford DE, Smith PL, Punjabi NM. Differences in patient and bed partner-assessed quality of life in sleep-disordered breathing. Am J Respir Crit Care Med 2004; 170: 547-52.
14. Parish JM, Lyng PJ. Quality of life in bed partners of patients with obstructive sleep apnea or hypopnea after treatment with continuous positive airway pressure. Chest 2003; 124: 942-7.
15. Siccoli MM, Pepperell JCT, Kohler M, Craig S, Davies RJO, Stradling JR. Effect of continuous positive airway pressure on quality of life in patients with moderate to severe obstructive sleep apnea: data from a randomized controlled trial. Sleep 2008; 31: 1551-8.
16. Beninati W, Harris CD, Herold DL, Shepard JW. The effect of snoring and obstructive sleep apnea on the sleep quality of bed partners. Mayo Clin Proc 1999; 74: 955-8.
17. Cartwright R. Sleeping together: a pilot study of the effects of shared sleeping on adherence to CPAP treatment in obstructive sleep apnea. J Clin Sleep Med 2008; 4: 123-7.
18. Lee RWW, Chan ASL, Grunstein RR, Cistulli PA. Craniofacial phenotyping in obstructive sleep apnea-a novel quantitative photographic approach. Sleep 2009; 32: 37-45.
19. Hoekema A, Hovinga B, Stegenga B, De Bont LGM. Craniofacial morphology and obstructive sleep apnea: a cephalometric analysis. J Oral Rehabil 2003; 30: 690-6.
20. Akashiba T, Kosaka N, Yamamoto H, Ito D, Saito O, Horie T. Optimal continuous positive airway pressure in patients with obstructive sleep apnea: role of craniofacial structure. Respir Med 2001; 95: 393-7.
21. Tsai HH, Ho CY, Lee PL, Tan CT. Sex differences in anthropometric and cephalometric characteristics in the severity of obstructive sleep apnea syndrome. Am J Orthod Dentofacial Orthop 2009; 135: 155-64.
22. Collen J, Lettieri C, Kelly W, Roop S. Clinical and polysomnographic predictors of short term continuous positive airway pressure compliance. Chest 2009; 135:704-9.
23. Richard W, Venker J, den Herder C, Kox D, van den Berg B, Laman M, et al. Acceptance and longterm compliance of nCPAP in obstructive sleep apnea. Eur Arch Otorhinolaryngol 2007; 264: 1081-6.
24. Yetkin O, Kunter E, Gunen H. CPAP compliance in patients with obstructive sleep apnea syndrome. Sleep Breath 2008; 12: 365-7.
25. Kakkar RK, Berry RB. Positive airway pressure treatment for obstructive sleep apnea. Chest 2007; 132: 1057-72.
26. Sin DD, Mayers I, Man GCW, Pawluk L. Long-term compliance rates to continuous positive airway pressure in obstructive sleep apnea. Chest 2002; 121: 430-5.