Long-term adherence to CPAP treatment in patients with obstructive sleep apnea: importance of educational program

Giuseppe Emanuele La Piana¹, Alessandro Scartabellati¹, Lodovico Chiesa¹, Luca Ronchi¹, Paola Raimondi¹, Miriam A Carro¹, Silvia Zibetti¹, Stefano Aiolfi^2
1Pulmonary Rehabilitation Unit, S. Marta Hospital, Rivolta D'Adda; ²Unit of Pneumology, AO Ospedale Maggiore di Crema, Crema, Italy

Background: Lack of adherence with continuous positive airway pressure (CPAP) therapy is the major cause of treatment failure in patients with obstructive sleep apnea syndrome. We evaluated the effectiveness of our intensive educational program on adherence in the short term and the long term.
Methods: The educational program consisted of: intensive training, whereby each patient performed individual and collective sessions of three hours receiving information about obstructive sleep apnea syndrome, familiarizing themselves with CPAP tools, on six consecutive days; long-term training; and support meetings, with reassessment at three months and one year.
Results: In 202 patients with obstructive sleep apnea syndrome, the mean (standard deviation) apnea/hypopnea index was 45 ± 22, the Epworth Sleepiness Scale score was 14 ± 5, and the average titration pressure was 10 ± 2 cm H₂O. At three months, 166 patients (82%) used CPAP for an average of 7.3 hours per night. At one year, 162 (80%) used CPAP for about seven hours per night. At two years, 92 patients (43%) used CPAP for about five hours per night. The level of satisfaction remained higher in patients in ventilation.
Conclusion: Our data show strong adherence to CPAP at three months and one year, with a decrease at two years. The initial educational program seems to play an important role in adherence. This effect is lost in the long term, suggesting that periodic reinforcement of educational support would be helpful.

Keywords: adherence, continuous positive airway pressure, obstructive sleep apnea syndrome, educational program