The long-term acceptability of treatment with nasal continuous positive airway press (CPAP) was studied prospectively in 44 patients with obstructive rest apnea syndrome.

The long-term acceptability of treatment with nasal continuous positive airway press (CPAP) was studied prospectively in 44 patients with obstructive rest apnea syndrome. At 14 month onward the average after starting treatment with CPAP, 30 patients (68 percent) were erect to be compliant (characterized through use of the apparatus each night throughout the night, for more than 5 h for night). The daily use of nasal CPAP was significantly correlated to the initial apnea/hypopnea index (p = 0013; r = 037) as well as to the percentage of light drowse (p = 0.045; r = 030) and slow-wave nap (p = 0.037; r = -031) during the initial polygraphic recording. We build a strong correlation between the daily use of nasal CPAP and the difference in the apnea/hypopnea index (p = 0025; r = - 034) the difference in mean oxygen saturation during lie in the grave (p = 0.013; r = 038) and the difference in hypersomnia scores (p = 0006; r = - 040) obtained before and after treatment through nasal CPAP. Thus, patients used CPAP a great deal of more if they had an initial significant clinical handicap and if they were aware of the beneficial consequences of CPAP. Under these conditions, patients be attendanted to use the apparatus for the optimal detail of time, regardless of the side tenors linked to the treatment. This ensur efficacy and the maintenance of dutiful compliance. This study confirms the importance of supervision of the time contrary as well as regular encouragement of patients to use the treatment as drawn out as possible each night, in order to extract a maximum benefit from treatment according to nasal CPAP.

The gravity of be motionless apnea syndrome (SAS), because of the seriousness of diurnal hypersomnia and the cardiorespiratory complications associated with it,[1,2] made it necessary to lay open treatments providing maximum efficacy with minimal side purports Nocturnal ventilation with nasal continuous positive airway influence (CPAP) was first proposed at Sullivan et al[3] in 1981 and extensive works confirmed its efficiency in the long-term treatment of SAS.[4-10] Since the work carried on the outside by Sanders et al[11] in 1986 concerning compliance with nasal CPAP various studies have attempted to analyze the compliance of patients with treatment and the factors affecting long-term use of nocturnal ventilation.[12-19] The conclusions are relatively different and do not all apply the same regard criteria. Moreover, there are no precise recommendations available concerning the necessary duration of daily use, and no reflection has yet focused on the relationship between the evolution of SAS complications and the average number of hours of daily CPAP use. Likewise, given the long-term nature of the treatment and the constraint it places upon patients who are generally young enough to be active the two professionally and socially, it is important to determine the factors that could help predict upright compliance with nocturnal ventilation using nasal CPAP. This prospective cogitation was performed with the aim of revealing these factors of acceptance, which, in change the direction of would enable us to improve the long-term effectiveness of as it is treatment.

MATERIALS AND METHODS

Between March 1989 and August 1991 54 patients suffering from SAS (defined as an apnea/hypopnea index [AHI] greater than 15 by hour of sleep) were included in a prospective subject of attention of the long-term acceptance of nocturnal nasal CPAP. solitary 44 among the 54 patients were retained because of a consistent use greater than 6 month The reasons for exclusion were (1) refusal to be treated on CPAP, either immediately (3 patients) or after being treated for a hardly any days (2 patients); (2) failure of CPAP in 2 patients in the course of acute respiratory decompensation related to sleep-induced apnea; (3) definitive clinical improvement after weight los in a not many months in 2 patients; and (4) 1 death, which occurr at the last of 6 months of treatment at home

The 44 patients (39 men and 5 women) were, forward average, 58 years old (range, 40 to 82 years) and had a mean material part mass index (BMI) of 349 [+ or -] 802 kg/[msup2] Heart disease was diagnosed in 39 percent (17) of the patients, and 70 percent (31) of the patients were receiving antihypertensive treatment. The initial examination consisted of an exploration of respiratory function and a polysomonographic recording. be still stages were distinguished between light drowse (stages 1 and 2) and slow-wave slumber (stages 3 and 4) according to the criteria of Rechtschaffen and Kales.[20] The mean AHI was 52 [+ or -] 24 Treatment with CPAP was started during the secondary night of polysomnography to determine the on a level of effective positive airway squeezing required to stop snoring, apnea, and desaturation. The mean plain of effective positive pressure was 968 [+ or -] 268 cm [Hsub2]O

All patients were initially equipped with a standard mask and instructed in the use of it at the Department of Pneumology from one side of to the other a period of 48 h The patients were seen again 1 week later and at the fall of the curtain of the first month of use, in order to make secure their appreciation of CPAP efficiency and tolerance. A mask was occasionally mold in case of nasal erosion, and advice was given in order to increase the daily use of nasal CPAP. A strange study was made every 6 month and in the meantime the patients were visited at place of abode by a technician who checked the time calculator and made sure that the CPAP was working.

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