The Victorian CPAP Program: is there a need for additional education and support?

• Published in: Internal medicine journal Vol. 32; no. 11; pp. 526 - 532
• Main Authors: Manser, R. L., Naughton, M. T., Pierce, R. J., Sasse, A., Teichtahl, H., Ho, M., Campbell, D. A.
• Format: Journal Article Conference Proceeding
• Language: English
• Published: Oxford, UK Blackwell Science Pty 01-11-2002; Blackwell Science
• Subjects: Adolescent; Adult; Aged; Biological and medical sciences; CPAP; Diseases of the upper aerodigestive tract; Ent and stomatology; Female; Health Status Indicators; health-services research; Humans; Male; Medical sciences; Middle Aged; Non tumoral diseases; Otorhinolaryngology. Stomatology; Positive-Pressure Respiration - adverse effects; Prospective Studies; Quality of Life; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Sleep Apnea Syndromes - therapy; sleep apnoea syndromes; subjective daytime sleepiness; Surveys and Questionnaires; Treatment Outcome; Tropical medicine; Upper respiratory tract, upper alimentary tract, paranasal sinuses, salivary glands: diseases, semeiology; Victoria; Australia; Oceania; Victoria; Performance evaluation; Human; Sleep apnea syndrome; Questionnaire; Treatment; Positive pressure; Treatment efficiency; Secondary effect; ENT disease; Therapeutic schedule; Quality of life
• ISSN: 1444-0903; 1445-5994
• DOI: 10.1046/j.1445-5994.2002.00295.x

Background : The Victorian Continuous Positive Airways Pressure (CPAP) Program provides CPAP services to financially disadvantaged individ­uals with moderate to severe sleep apnoea.
Aims : To evaluate health outcomes in patients referred to the pilot program in order to: (i) assess the magnitude of health benefit from treatment in this highly selected population and (ii) identify patient characteristics or factors related to service provision that may influence outcome.
Methods : We adopted a simple before−after research design. Patients who were referred to the program were recruited from five sleep centres. Questionnaires were administered at baseline and 1 and 3 months after commencing CPAP. Generic and disease‐­specific quality of life were assessed using the MOS 36‐Item Short‐form Health Survey and the Sleep Apnoea Quality‐of‐life Index, respectively. Sub­jective daytime sleepiness was measured using the Epworth Sleepiness Scale and the Sleep−Wake Activity ­Inventory.
Results : Of the 68 subjects enrolled in the study, 59 were available for follow up. There were significant improvements in daytime sleepiness (P < 0.0005). Treatment‐related symptoms had a negative impact on overall disease‐specific quality of life, how­ever there were significant improvements in all other domains of disease‐specific quality of life (P < 0.0005). Improvements in generic quality of life were small but statistically significant (P < 0.05). Hospital, disease severity, baseline sleepiness, gender and CPAP‐machine type were not predictors of outcome (P > 0.05).
Conclusion : This review of the Victorian CPAP Program identified significant improvements in sub­jective daytime sleepiness and quality of life, despite the negative impact of treatment‐related symptoms. Future research should explore whether services can be modified to help reduce the impact of treatment‐related side‐effects. (Intern Med J 2002; 32: 526−532)