Night-to-night variability in CPAP use over the first three months of treatment

• Published in: Sleep (New York, N.Y.) Vol. 20; no. 4; pp. 278 - 283
• Main Authors: WEAVER, T. E, KRIBBS, N. B, DINGES, D. F, PACK, A. I, KLINE, L. R, CHUGH, D. K, MAISLIN, G, SMITH, P. L, SCHWARTZ, A. R, SCHUBERT, N. M, GILLEN, K. A
• Format: Journal Article
• Language: English
• Published: Rochester, MN American Academy of Sleep Medicine 01-04-1997
• Subjects: Adult; Biological and medical sciences; Diseases of the upper aerodigestive tract; Ent and stomatology; Female; Humans; Male; Medical sciences; Microcomputers; Middle Aged; Monitoring, Physiologic - instrumentation; Patient Compliance - psychology; Positive-Pressure Respiration - instrumentation; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Sleep Apnea Syndromes - psychology; Sleep Apnea Syndromes - therapy; Treatment Outcome; Human; Sleep apnea syndrome; Intraindividual comparison; Positive pressure; Upper respiratory tract; Continuous; Treatment efficiency; Sleep disorder; ENT disease; Treatment compliance; Obstruction; Mechanical ventilation
• ISSN: 0161-8105; 1550-9109
• DOI: 10.1093/sleep/20.4.278

The purpose of this study was to examine the relationship between night-to-night variability and nightly duration of continuous positive airway pressure (CPAP) therapy over the first 9 weeks of treatment and to determine when patients begin to establish a nonadherent pattern of use. Data were analyzed from a study of daily CPAP use covertly monitored in 32 diagnosed patients with obstructive sleep apnea (OSA) using a microprocessor monitor encased in a CPAP machine. Patterns of CPAP use were bimodal, based on the frequency of nightly use. Approximately half the subjects were consistent users of CPAP, applying it > 90% of the nights for an average of 6.22 +/- 1.21 hours per night, while the other half comprised intermittent users who had a wide range of daily use averaging 3.45 +/- 1.94 hours per night on the nights CPAP was used. The percent of days skipped was significantly correlated with decreased nightly duration (rho = -0.73, p < 0.0001). Analysis of the night-to-night pattern of use revealed that the two groups differed significantly in the nightly duration of CPAP use by the fourth day of treatment (p = 0.001). Exploration of factors that potentially differentiate the two groups revealed no reliable predictors. However, intermittent users continued to report significantly greater OSA symptoms (snoring, snorting, and apnea) posttreatment, suggesting that they continued to experience sleep disordered breathing.