MONTREAL -- The dismal compliance of sleep apnea patients withcontinuous positive airway pressure tr...

1. Support and education for CPAP patients can improve
compliance.
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

2. 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

3. 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

4. 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.