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Effects of intensive outpatient training on the adherence of CPAP therapy for patients with OSA

A randomised trial

Effekt intensiven ambulanten Trainings auf die Adhärenz der CPAP-Therapie von OSA-Patienten

Eine randomisierte Studie

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Abstract

Background

Continuous positive airway pressure (CPAP) is the treatment of choice for obstructive sleep apnoea (OSA). Long-term adherence is still an unsolved problem in this treatment, although different technical modifications for pressure application have been introduced. The only proven intervention to increase therapy adherence is an intensive training programme [1].

Subjects and methods

Eighty-four patients with the first diagnosis of OSA completed an intensive CPAP education programme during an in-hospital sleep laboratory stay. In this randomised prospective study the patients were treated as usual (control group) or enrolled in an outpatient training programme consisting of additional weekly telephone calls and an outpatient follow-up appointment with personal and technical support after 6 weeks. The mean daily use of CPAP was determined by reading off the internal clock of the devices, and daytime sleepiness was characterised using the Epworth Sleepiness Scale (ESS).

Results

In all, 22% of the patients rejected the therapy (mean use of less than 1 h per night). For the rest, the mean use of CPAP was 4.6± 2.7 h in the control group and 4.3± 1.8 h in the intervention group (no statistically significant difference).

Conclusion

After an intensive introduction to CPAP therapy in an inpatient environment, no increase in therapy adherence could be achieved via weekly telephone calls and a follow-up appointment.

Zusammenfassung

Hintergrund

Die Behandlung mit einem kontinuierlichen positiven Atemwegsdruck (CPAP) ist das etablierte Standardverfahren für die obstruktive Schlafapnoe (OSA). Allerdings ist die Langzeitadhärenz ein ungelöstes Problem, obwohl verschiedene technische Modifikationen der Druckapplikation in die Behandlung eingeführt worden sind. Eine Verbesserung der Adhärenz konnte bisher allein durch eine intensivierte Schulung erreicht werden.

Methoden

Während einer stationären Behandlung im Schlaflabor durchliefen 84 Patienten mit der erstmaligen Diagnose einer OSA ein intensives CPAP-Schulungsprogramm. In der randomisierten prospektiven Studie wurden die Patienten nach Entlassung entweder in üblicher Weise (Kontrollgruppe) oder in einem ambulanten Trainingsprogramm (Interventionsgruppe) betreut. Das ambulante Trainingsprogramm bestand aus wöchentlichen Telefonanrufen und einem Kontrolltermin mit ärztlicher und technischer Betreuung nach 6 Wochen. Die mittlere nächtliche Nutzung der CPAP-Therapie wurde über die in den Geräten befindlichen Speichermedien, die Schläfrigkeit über die Epworth Sleepiness Scale (ESS) ermittelt.

Ergebnisse

In der gesamten Gruppe haben 22% aller Patienten die Therapie abgebrochen (definiert als eine Nutzung von weniger als 1 h pro Nacht). Unter den Patienten, die die CPAP-Therapie nutzten, fand sich mit 4,3± 1,8 (Interventionsgruppe) versus 4,6± 2,7 h (Kontrollgruppe) kein Unterschied.

Schlussfolgerung

Nach einer intensiven Schulung der Patienten im Rahmen eines stationären Schlaflaboraufenthalts kann durch zusätzliche Schulungsmaßnahmen in Form von wöchentlichen telefonischen Kontakten und einem Kontrolltermin keine Steigerung der Adhärenz erreicht werden.

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Conflict of interest

On behalf of all authors, the corresponding author states that there are no conflicts of interest.

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Authors and Affiliations

  1. Department of pneumology, sleep medicine and critical care medicine, HELIOS Klinik Hagen-Ambrock, University of Witten/Herdecke, Ambrocker Weg 60, 58091, Hagen, Germany

    G. Nilius MD, U. Domanski, T. van’t Hoog, K.-J. Franke, S. Burian & K.-H. Ruehle

  2. Westphalia health insurer medical service, Westphalia, Germany

    U. Cottin

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  1. G. Nilius MD
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  2. U. Cottin
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  3. U. Domanski
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Correspondence to G. Nilius MD.

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Nilius, G., Cottin, U., Domanski, U. et al. Effects of intensive outpatient training on the adherence of CPAP therapy for patients with OSA. Somnologie 16, 251–256 (2012). https://doi.org/10.1007/s11818-012-0580-y

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