When properly used, CPAP can perfectly treat sleep apnea. It can be 100% effective at eliminating sleep apnea when used as recommended.
The problem is that many–potentially most–people do not use their CPAP machines as recommended. This means that when people are prescribed CPAP treatment, many of them end up with their sleep apnea still untreated.
Now a new study shows that those who most need to get their sleep apnea treated are the very people who are least likely to comply with CPAP treatment. In particular, the study shows that people with high blood pressure and irregular heart function are less likely to use CPAP. In other words, CPAP is more likely to fail people who need it more.
Retrospective Chart Review
This study was designed as a retrospective chart review with the goal of determining what factors impacted CPAP compliance. To qualify for the study, patients had have been prescribed CPAP, and they must have had a sleep study to confirm the sleep apnea diagnosis. Of 450 patients originally considered, only 42 qualified.
This study used the common compliance standard for CPAP of at least 4 hours treatment a night on 70% of nights, even though this is actually an average of only 2.8 hours of CPAP a night. Even using this relatively low compliance standard, only 55% of patients achieved compliance, although 67% of patients tried to achieve compliance.
After looking at the characteristics of patients associated with poor compliance, researchers identified three:
- High blood pressure
- Atrial fibrillation
- High mask leakage
Atrial fibrillation is an irregular heartbeat that has been associated with sleep apnea in previous studies. It can lead to an increased risk of heart failure or stroke. In this study, the correlation with poor CPAP compliance was notable, although not statistically significant as the others were.
The only factor that correlated with improved CPAP compliance was moderate sleep apnea.
Limitations of the Study
Although the insight of this study is important, we have to remember that it comes with certain limitations. Perhaps the most important is that these results were presented at a scholarly conference, not published in a journal. This means that the results have not undergone full peer review and should be considered preliminary. It is also important to note the small population size in the study. This makes it harder to achieve statistical significance with the findings, which might explain why atrial fibrillation, although correlated with poor compliance, did not achieve statistical significance.
However, these weaknesses do not mean we should throw out the results entirely, especially since previous studies have shown that poor compliance is common among heart patients. For example, an earlier study showed that cardiac patients who used their CPAP did not have to be readmitted for treatment, but only 19% of patients used their CPAP.
How to Address the Problem of Poor Compliance
So, what can we do about poor compliance with CPAP? Some people will benefit from strategies that can improve compliance. Telemonitoring and support can help people do better with CPAP. Couples therapy has also been shown to help compliance. This approach is best for people who have central sleep apnea and need CPAP.
But for many people, it is best to find an alternative sleep apnea treatment. Oral appliances achieve the same functional outcomes as CPAP, treating sleep apnea and related snoring. And compliance with oral appliances is much higher, which means that people who need treatment for their sleep apnea are more likely to get it.
If you are looking for an alternative to CPAP in St. Louis, we can help. Please call (314) 678-7876 (Downtown St. Louis) or (314) 678-7876 (Clayton) today for an appointment with sleep dentist Dr. Chris Hill at City Smiles.
