Subjective sleepiness is not required to adhere to cpap therapy

• Published in: Sleep medicine Vol. 14; pp. e154 - e155
• Main Authors: Hosokawa, K, Sariola, R, Huhtala, H, Polo, O
• Format: Journal Article
• Language: English
• Published: Elsevier B.V 01-12-2013
• Subjects: Neurology; Sleep Medicine
• DOI: 10.1016/j.sleep.2013.11.354
• EISSN: 1878-5506
• ISSN: 1389-9457

Introduction Randomized controlled studies have proved the efficacy of CPAP therapy in patients with obstructive sleep apnea syndrome (OSAS) with subjective sleepiness (ESS higher than 10). However, half of the patients with OSAS do not suffer from excessive sleepiness (Lavie 2007) and they may be less motivated to adherence to CPAP therapy. Materials and methods We enrolled 1493 patients (71% males) who were diagnosed with obstructive sleep apnea and started with CPAP therapy at Tampere University Hospital Sleep Clinic. Median AHI was 20.7/h in bed and median ESS 9.0/24. ESS was controlled after 3 and 12-month visits. Results At 12-month follow-up, CPAP was still being used by 939 subjects (63%), while 554 subjects had discontinued CPAP. 65.6 % of those with initial excessive sleepiness (ESS > 10) and 61.0% of those without sleepiness (ESS < 11) at the time of diagnosis remained adherent to CPAP at 12-month follow-up. In a multivariate analysis, adherence to CPAP at 12 month follow-up was predicted by AHI, BMI and improvement of sleepiness at 3-month follow-up visit. Conclusion About two thirds of patients with OSAS, irrespective of whether they feel sleepy or not, adhere to CPAP. Placebo-response is unlikely to motivate patients with OSAS to become regular CPAP users. The benefits may include better sleep quality and/or less impact of obesity of other co-morbidities. How to measure the benefits of long-term CPAP therapy in patients with OSAS but without sleepiness remains a challenge for randomized controlled studies. Acknowledgement The team would like to thank the staff at Tampere University Hospital Sleep Clinic.