Updated guidelines issued by the American Academy of Sleep Medicine (AASM) (. 2006; 29:375-380) support continuous positive airway pressure (CPAP) devices as the standard treatment for the 2% to 4% of American adults who have obstructive sleep apnea (OSA).
Lawrence J. Epstein, MD, the president of the AASM, told that although this prevalence is similar to that of asthma, "the majority of people who have obstructive sleep apnea probably have still not been diagnosed."
Consequences of untreated OSA include hypertension, heart disease, and stroke. "On top of that, people with sleep apnea don't feel very good, because they tend to be excessively sleepy, and this impairs their ability to do their jobs, puts them at higher risk of automobile accidents, and reduces their quality of life," he said.
CPAP is essentially 100% successful in eliminating the obstruction in the airway, according to Dr Epstein. "What limits it is that you have to wear it for it to be successful. As with any chronic medical therapy, including medications for hypertension and diabetes, not everybody who has it uses it."
He discussed 4 measures that have been shown to improve compliance:
? Ensure that the patient is comfortable with the interface (ie, the mask and the method of delivering the positive airway pressure). "Just like with all sorts of things?what kind of pillow you like, or mattress, or foods?people have different tolerances."
? Do everything possible to optimize the patient's sleep in the very early treatment period (eg, prescribe sleeping medications for early, short-term use). "Research has shown that patterns of use are established very early?as early as by 1 week."
? Treat complications, such as dryness, nasal congestion, and skin irritation. "Making sure that you address each of these issues improves the comfort of the device and therefore the likelihood they'll wear it."
? Education and support. "Let people know the value of using CPAP, the consequences of untreated sleep apnea, what they should be looking for, and the impact on other disorders like hypertension and weight, and schedule regular follow-up visits to check on how they're doing."
The "take-home message," Dr Epstein says, "is that OSA is a common disorder, but you need to look for it to find it. Patients don't always recognize that this is something they should go to their doctor about. People need to know that there are both effective treatments and specialists in sleep disorders who can help them improve their quality of life and overall health and well-being."
Recommendations for CPAP use in OSA : Patients with moderate- to-severe disease in whom the diagnosis of OSA has been established (eg, by polysomnography) Can be considered in patients with mild OSA
: To improve self- reported sleepiness : To improve quality of life
: Adjunctive therapy to lower blood pressure in patients with comorbid hypertension Recommendations to improve compliance Objective monitoring of CPAP use
Close follow-up to establish use and problem solving during first weeks of therapy
Add heated humidification
Institute a systematic educational program
Long-term follow-up to solve any mask, machine, or usage problems
CPAP = continuous positive airway pressure; OSA = obstructive sleep apnea.
Source: Sleep. 2006;29:375-380.