Can Intensive Support Improve Continuous Positive Airway Pressure Use in Patients with the Sleep Apnea/Hypopnea Syndrome?

TLDR

Continuous positive airway pressure (CPAP) therapy is widely prescribed for patients with sleep apnea/hypopnea syndrome (SAHS), yet its utilization remains disappointingly low. The study aimed to determine whether intensive educational programs and nursing support would increase CPAP use and outcomes in SAHS patients, and whether patients who initiated their own referral would use CPAP more than those prompted by a partner. Eighty new SAHS patients were randomized to usual support or an intensive program that included home CPAP education, partner involvement, a 3‑night sleep‑center trial, and follow‑up home visits. Intensive support raised average nightly CPAP use from 3.9 to 5.4 hours and improved symptoms, mood, and reaction time, while patients who self‑initiated referrals used CPAP more and those whose partners prompted them used it less.

Abstract

Continuous positive airway pressure (CPAP) therapy is widely prescribed for patients with the sleep apnea/hypopnea syndrome (SAHS), but the use of CPAP for such patients is disappointingly low. We postulated that providing intensive educational programs and nursing support to SAHS patients might improve CPAP use and outcomes. We also examined the hypothesis that CPAP use would be greater among patients who had initiated their own referral than among those asked to seek help by a partner. We randomized 80 consecutive, new patients with SAHS to receive either usual support or additional nursing input including CPAP education at home and involving their partners, a 3-night trial of CPAP in our institution's sleep center, and additional home visits once they had begun CPAP. The primary outcome variable was objective CPAP use; symptoms, mood, and cognitive function were also assessed after 6 mo. CPAP use over 6 mo was greater (p = 0.003) among patients receiving intensive than among those receiving standard support (5.4 ± 0.3 versus 3.9 ± 0.4 h/night [mean ± SEM]), with greater improvements (p < 0.05) in SAHS symptoms, mood, and reaction time in the intensively supported group. CPAP use was greater (p = 0.002) among patients who initiated their own referrals. CPAP use and outcomes of therapy can be improved by provision of a nurse-led intensive CPAP education and support program. CPAP use is lower among patients whose partners ask them to seek treatment.