MK Reeves-Hoche, R Meck and CW Zwillich
Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, Hershey 17033.

Nasal continuous positive airway pressure (NCPAP) improves sleepiness and prognosis in obstructive sleep apnea (OSA). Our objective was to document NCPAP compliance and the percentage of time that the effective pressure shown to eliminate 95% of the obstructive apneas and hypopneas was maintained. We built and covertly installed an elapsed timer and mask pressure transducer recorder in NCPAP units of 47 OSA patients. Subjects were seen at 2- to 8-wk intervals over 6 months. Group mean age was 51 yr; 38 males, with mean body mass index of 42; all complained of daytime sleepiness. Initial full night polysomnography demonstrated a mean apnea-hypopnea index (AHI) of 58 +/- 2.6 SEM (range, 10 to 115). Nine subjects discontinued therapy within 3 months for various reasons. In the remaining subjects (n = 38) the actual mean nightly hours of use was 4.7 which represents 68% of the stated total sleep time (compliance). However, effective mean hours of use was 4.3 which represents 91% of the time that prescribed effective pressure was maintained at the mask. The AHI did not correlate with compliance, but did correlate with effective use (R = 0.27048, p = 0.0006). Subjective initial complaints of daytime sleepiness correlated with compliance only during the first visit (R = 0.38590, p = 0.05). No predictors for compliance were found.

This article has been cited by other articles:

				T. E. Weaver and R. R. Grunstein Adherence to Continuous Positive Airway Pressure Therapy: The Challenge to Effective Treatment Proceedings of the ATS, February 15, 2008; 5(2): 173 - 178. [Abstract] [Full Text] [PDF]

				B. Mokhlesi, M. H. Kryger, and R. R. Grunstein Assessment and Management of Patients with Obesity Hypoventilation Syndrome Proceedings of the ATS, February 15, 2008; 5(2): 218 - 225. [Abstract] [Full Text] [PDF]

				N. J. Buchner, B. M. Sanner, J. Borgel, and L. C. Rump Continuous Positive Airway Pressure Treatment of Mild to Moderate Obstructive Sleep Apnea Reduces Cardiovascular Risk Am. J. Respir. Crit. Care Med., December 15, 2007; 176(12): 1274 - 1280. [Abstract] [Full Text] [PDF]

				B. Mokhlesi and A. Tulaimat Recent Advances in Obesity Hypoventilation Syndrome Chest, October 1, 2007; 132(4): 1322 - 1336. [Abstract] [Full Text] [PDF]

				R. K. Kakkar and R. B. Berry Positive Airway Pressure Treatment for Obstructive Sleep Apnea Chest, September 1, 2007; 132(3): 1057 - 1072. [Abstract] [Full Text] [PDF]

				H.-S. Lin, A. S. Prasad, C.-J. G. Pan, and J. A. Rowley Factors Associated With Noncompliance to Treatment With Positive Airway Pressure Arch Otolaryngol Head Neck Surg, January 1, 2007; 133(1): 69 - 72. [Abstract] [Full Text] [PDF]

				J. Rigau, J. M. Montserrat, H. Wohrle, D. Plattner, M. Schwaibold, D. Navajas, and R. Farre Bench model to simulate upper airway obstruction for analyzing automatic continuous positive airway pressure devices. Chest, August 1, 2006; 130(2): 350 - 361. [Abstract] [Full Text] [PDF]

				L. C. Dort, E. Hadjuk, and J. E. Remmers Mandibular advancement and obstructive sleep apnoea: a method for determining effective mandibular protrusion. Eur. Respir. J., May 1, 2006; 27(5): 1003 - 1009. [Abstract] [Full Text] [PDF]

				M. Sucena, G. Liistro, G. Aubert, D. O. Rodenstein, and T. Pieters Continuous positive airway pressure treatment for sleep apnoea: compliance increases with time in continuing users. Eur. Respir. J., April 1, 2006; 27(4): 761 - 766. [Abstract] [Full Text] [PDF]

				C. L. Marcus, G. Rosen, S. L. D. Ward, A. C. Halbower, L. Sterni, J. Lutz, P. J. Stading, D. Bolduc, and N. Gordon Adherence to and Effectiveness of Positive Airway Pressure Therapy in Children With Obstructive Sleep Apnea Pediatrics, March 1, 2006; 117(3): e442 - e451. [Abstract] [Full Text] [PDF]

				C. S. McCrae and P. T. Ingmundson Using Graduated in Vivo Exposure to Treat a Claustrophobic Response to Nasal Continuous Positive Airway Pressure: Hispanic Male Veteran Associates Nasal Mask With Gas Masks Worn During Combat Clinical Case Studies, February 1, 2006; 5(1): 71 - 82. [Abstract] [PDF]

				M. Orth, H-W. Duchna, M. Leidag, W. Widdig, K. Rasche, T. T. Bauer, J. W. Walther, J. de Zeeuw, J-P. Malin, G. Schultze-Werninghaus, et al. Driving simulator and neuropsychological testing in OSAS before and under CPAP therapy Eur. Respir. J., November 1, 2005; 26(5): 898 - 903. [Abstract] [Full Text] [PDF]

				M. Duong, L. Jayaram, D. Camfferman, P. Catcheside, I. Mykytyn, and R. D. McEvoy Use of heated humidification during nasal CPAP titration in obstructive sleep apnoea syndrome Eur. Respir. J., October 1, 2005; 26(4): 679 - 685. [Abstract] [Full Text] [PDF]

				P Gordon and M H Sanders Sleep {middle dot} 7: Positive airway pressure therapy for obstructive sleep apnoea/hypopnoea syndrome Thorax, January 1, 2005; 60(1): 68 - 75. [Abstract] [Full Text] [PDF]

				P. Lloberes, S. Marti, G. Sampol, A. Roca, T. Sagales, X. Munoz, and M. Ferrer Predictive Factors of Quality-of-Life Improvement and Continuous Positive Airway Pressure Use in Patients With Sleep Apnea-Hypopnea Syndrome: Study at 1 Year Chest, October 1, 2004; 126(4): 1241 - 1247. [Abstract] [Full Text] [PDF]

				A. Bachour and P. Maasilta Mouth Breathing Compromises Adherence to Nasal Continuous Positive Airway Pressure Therapy Chest, October 1, 2004; 126(4): 1248 - 1254. [Abstract] [Full Text] [PDF]

				M.R. Wild, H.M. Engleman, N.J. Douglas, and C.A. Espie Can psychological factors help us to determine adherence to CPAP? A prospective study Eur. Respir. J., September 1, 2004; 24(3): 461 - 465. [Abstract] [Full Text] [PDF]

				F. Gagnadoux, X.L. Nguyen, D. Rakotonanahary, S. Vidal, and B. Fleury Wrist-actigraphic estimation of sleep time under nCPAP treatment in sleep apnoea patients Eur. Respir. J., June 1, 2004; 23(6): 891 - 895. [Abstract] [Full Text] [PDF]

				M K Johnson, R Carter, A Nicol, R Paton, and S W Banham Long-term continuous positive airway pressure (CPAP) outcomes from a sleep service using limited sleep studies and daycase CPAP titration in the management of obstructive sleep apnoea/hypopnoea syndrome Chronic Respiratory Disease, April 1, 2004; 1(2): 83 - 88. [Abstract] [PDF]

				L. S. Doherty, J. L. Kiely, G. Lawless, and W. T. McNicholas Impact of Nasal Continuous Positive Airway Pressure Therapy on the Quality of Life of Bed Partners of Patients With Obstructive Sleep Apnea Syndrome Chest, December 1, 2003; 124(6): 2209 - 2214. [Abstract] [Full Text] [PDF]

				A.M. Neill, H.S. Wai, S.P.T. Bannan, C.R. Beasley, M. Weatherall, and A.J. Campbell Humidified nasal continuous positive airway pressure in obstructive sleep apnoea Eur. Respir. J., August 1, 2003; 22(2): 258 - 262. [Abstract] [Full Text] [PDF]

				M. R. Littner Continuous Positive Airway Pressure: By Nose or Mouth? Chest, March 1, 2003; 123(3): 662 - 664. [Full Text] [PDF]

				C. A. Massie, N. McArdle, R. W. Hart, W. W. Schmidt-Nowara, A. Lankford, D. W. Hudgel, N. Gordon, and N. J. Douglas Comparison between Automatic and Fixed Positive Airway Pressure Therapy in the Home Am. J. Respir. Crit. Care Med., January 1, 2003; 167(1): 20 - 23. [Abstract] [Full Text] [PDF]

				J. R. PRINSELL Maxillomandibular advancement surgery for obstructive sleep apnea syndrome J Am Dent Assoc, November 1, 2002; 133(11): 1489 - 1497. [Abstract] [Full Text] [PDF]

				K. M. Hla, J. B. Skatrud, L. Finn, M. Palta, and T. Young The Effect of Correction of Sleep-Disordered Breathing on BP in Untreated Hypertension Chest, October 1, 2002; 122(4): 1125 - 1132. [Abstract] [Full Text] [PDF]

				N. MCARDLE and N. J. DOUGLAS Effect of Continuous Positive Airway Pressure on Sleep Architecture in the Sleep Apnea-Hypopnea Syndrome . A Randomized Controlled Trial Am. J. Respir. Crit. Care Med., October 15, 2001; 164(8): 1459 - 1463. [Abstract] [Full Text] [PDF]

				A. R. Schwartz, M. L. Bennett, P. L. Smith, W. De Backer, J. Hedner, A. Boudewyns, P. Van de Heyning, H. Ejnell, W. Hochban, L. Knaack, et al. Therapeutic Electrical Stimulation of the Hypoglossal Nerve in Obstructive Sleep Apnea Arch Otolaryngol Head Neck Surg, October 1, 2001; 127(10): 1216 - 1223. [Abstract] [Full Text] [PDF]

				C. MONASTERIO, S. VIDAL, J. DURAN, M. FERRER, C. CARMONA, F. BARBE, M. MAYOS, N. GONZALEZ-MANGADO, M. JUNCADELLA, A. NAVARRO, et al. Effectiveness of Continuous Positive Airway Pressure in Mild Sleep Apnea-Hypopnea Syndrome Am. J. Respir. Crit. Care Med., September 15, 2001; 164(6): 939 - 943. [Abstract] [Full Text] [PDF]

				G Popescu, M Latham, V Allgar, and M W Elliott Continuous positive airway pressure for sleep apnoea/hypopnoea syndrome: usefulness of a 2 week trial to identify factors associated with long term use Thorax, September 1, 2001; 56(9): 727 - 733. [Abstract] [Full Text] [PDF]

				D. S. C Hui, D. K. L. Choy, T. S. T. Li, F. W. S. Ko, K. K. Wong, J. K. W. Chan, and C. K. W. Lai Determinants of Continuous Positive Airway Pressure Compliance in a Group of Chinese Patients With Obstructive Sleep Apnea Chest, July 1, 2001; 120(1): 170 - 176. [Abstract] [Full Text] [PDF]

				K. G. HENKE, J. J. GRADY, and S. T. KUNA Effect of Nasal Continuous Positive Airway Pressure on Neuropsychological Function in Sleep Apnea-Hypopnea Syndrome . A Randomized, Placebo-controlled Trial Am. J. Respir. Crit. Care Med., March 15, 2001; 163(4): 911 - 917. [Abstract] [Full Text]

				J. Juhasz, H. Becker, W. Cassel, S. Rostig, and J-H. Peter Proportional positive airway pressure: a new concept to treat obstructive sleep apnoea Eur. Respir. J., March 1, 2001; 17(3): 467 - 473. [Abstract] [Full Text] [PDF]

				D. S. C. Hui, J. K. W. Chan, D. K. L. Choy, F. W. S. Ko, T. S. T. Li, R. C. C. Leung, and C. K. W. Lai Effects of Augmented Continuous Positive Airway Pressure Education and Support on Compliance and Outcome in a Chinese Population Chest, May 1, 2000; 117(5): 1410 - 1416. [Abstract] [Full Text] [PDF]

				K. K. Li, R. W. Riley, and C. Guilleminault An Unreported Risk in the Use of Home Nasal Continuous Positive Airway Pressure and Home Nasal Ventilation in Children: Mid-Face Hypoplasia Chest, March 1, 2000; 117(3): 916 - 918. [Abstract] [Full Text] [PDF]

				J. R. Prinsell Maxillomandibular Advancement Surgery in a Site-Specific Treatment Approach for Obstructive Sleep Apnea in 50 Consecutive Patients* Chest, December 1, 1999; 116(6): 1519 - 1529. [Abstract] [Full Text] [PDF]

				J. L. PÉPIN, J. KRIEGER, D. RODENSTEIN, A. CORNETTE, E. SFORZA, P. DELGUSTE, C. DESCHAUX, V. GRILLIER, and P. LÉVY Effective Compliance during the First 3 Months of Continuous Positive Airway Pressure . A European Prospective Study of 121 Patients Am. J. Respir. Crit. Care Med., October 1, 1999; 160(4): 1124 - 1129. [Abstract] [Full Text]

				C. A. Massie, R. W. Hart, K. Peralez, and G. N. Richards Effects of Humidification on Nasal Symptoms and Compliance in Sleep Apnea Patients Using Continuous Positive Airway Pressure Chest, August 1, 1999; 116(2): 403 - 408. [Abstract] [Full Text] [PDF]

				P. C Deegan, B. G Cooper, J. R Britton, N. S Jones, and W. J M Kinnear Prospective audit of a respiratory sleep disorders service at District General Hospital level Postgrad. Med. J., July 1, 1999; 75(885): 414 - 418. [Abstract] [Full Text]

				C. J. HOY, M. VENNELLE, R. N. KINGSHOTT, H. M. ENGLEMAN, and N. J. DOUGLAS Can Intensive Support Improve Continuous Positive Airway Pressure Use in Patients with the Sleep Apnea/Hypopnea Syndrome? Am. J. Respir. Crit. Care Med., April 1, 1999; 159(4): 1096 - 1100. [Abstract] [Full Text] [PDF]

				N. MCARDLE, G. DEVEREUX, H. HEIDARNEJAD, H. M. ENGLEMAN, T. W. MACKAY, and N. J. DOUGLAS Long-term Use of CPAP Therapy for Sleep Apnea/Hypopnea Syndrome Am. J. Respir. Crit. Care Med., April 1, 1999; 159(4): 1108 - 1114. [Abstract] [Full Text] [PDF]

				D. I. Loube, P. C. Gay, K. P. Strohl, A. I. Pack, D. P. White, and N. A. Collop Indications for Positive Airway Pressure Treatment of Adult Obstructive Sleep Apnea Patients: A Consensus Statement Chest, March 1, 1999; 115(3): 863 - 866. [Abstract] [Full Text] [PDF]

				A Woodcock and A Custovic Role of the indoor environment in determining the severity of asthma Thorax, August 1, 1998; 53(90002): S47 - 51. [Abstract] [PDF]

				H. M Engleman, S. E Martin, R. N Kingshott, T. W Mackay, I. J Deary, and N. J Douglas Randomised placebo controlled trial of daytime function after continuous positive airway pressure (CPAP) therapy for the sleep apnoea/hypopnoea syndrome Thorax, May 1, 1998; 53(5): 341 - 345. [Abstract] [Full Text]

				S. REDLINE, N. ADAMS, M. E. STRAUSS, T. ROEBUCK, M. WINTERS, and C. ROSENBERG Improvement of Mild Sleep-disordered Breathing with CPAP Compared with Conservative Therapy Am. J. Respir. Crit. Care Med., March 1, 1998; 157(3): 858 - 865. [Abstract] [Full Text] [PDF]