Long-term Use of CPAP Therapy for Sleep Apnea/Hypopnea Syndrome

TLDR

Patients with sleep apnea/hypopnea syndrome treated with nasal CPAP must use it long‑term to prevent symptom recurrence. The study aims to determine the extent of long‑term CPAP use and identify factors that influence it. The authors analyzed objective CPAP usage in 1,155 of 1,211 consecutive SAHS patients, with a median 22‑month follow‑up. Among 1,155 patients, 20% discontinued CPAP, 68% remained on therapy after five years, and early nightly use, snoring history, AHI, and Epworth score were strong predictors of continued use, with 86% of those with high Epworth and AHI ≥ 30 still using at three years.

Abstract

Patients with the sleep apnea/hypopnea syndrome (SAHS) treated by nasal continuous positive airway pressure (CPAP) need to use CPAP long-term to prevent recurrence of symptoms. It is thus important to clarify the level of long-term CPAP use and the factors influencing long-term use. We examined determinants of objective CPAP use in 1, 211 consecutive patients with SAHS who were prescribed a CPAP trial between 1986 and 1997. Prospective CPAP use data were available in 1, 155 (95.4%), with a median follow-up of 22 mo (interquartile range [IQR], 12 to 36 mo). Fifty-two (4.5%) patients refused CPAP treatment (these were more often female and current smokers); 1,103 patients took CPAP home, and during follow-up 20% stopped treatment, primarily because of a lack of benefit. Methods of survival analysis showed that 68% of patients continued treatment at 5 yr. Independent predictors of long-term CPAP use were snoring history, apnea/hypopnea index (AHI), and Epworth score; 86% of patients with Epworth > 10 and an AHI >/= 30 were still using CPAP at 3 yr. Average nightly CPAP use within the first 3 mo was strongly predictive of long-term use. We conclude that long-term CPAP use is related to disease severity and subjective sleepiness and can be predicted within 3 mo.