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a Department of
Respiratory Medicine, St James's University Hospital, Leeds LS9
7TF, UK, b Department of Medical Statistics
Correspondence to: Dr M W Elliott mark.elliott{at}gw.sjsuh.northy.nhs.uk
Received 15 May 2000; Returned to authors 15 August 2000; Revised version received 18 May 2001; Accepted for publication 4 June 2001
BACKGROUND
The sleep
apnoea/hypopnoea syndrome (SAHS) is common and treatment with
continuous positive airway pressure (CPAP) is effective. However, not
all patients can cope with the demands of using mask positive pressure.
Compliance can be improved with an intensive educational programme and
patient support, but this is not practical in most centres given the
large numbers of patients coming forward for treatment. Several studies
have evaluated correlations between various parameters at diagnosis in
order to anticipate patients' behaviour and to avoid the social and
health implications of undertreated SAHS. We have evaluated the use of
additional data derived during a 2 week home CPAP trial to identify
factors associated with longer term use of CPAP and compliance.
METHODSFollowing a
diagnostic study, 209 patients were offered a CPAP machine for a 2 week
home trial. After completing the trial, patients were reassessed and
scored their overall satisfaction with CPAP treatment on a five point
scale ranging from "much worse" to "much better" and an Epworth
score relating to the loan period. Machine run time was recorded from
the integral clock. These data were added to those available at
diagnosis to construct models indicative of continuing CPAP and average
nightly use at 1 year.
RESULTS209 patients
were offered the 2 week loan at least a year before June 1999 (90.9%
men, mean (SD) age 51.0 (10.6) years, body mass index (BMI) 34.6 (7.7) kg/m2, Epworth score 15 (IQR 11-18),
apnoea/hypopnoea index (AHI) 38.1 (22.9) events/h). 153 patients
(73.2%) opted to continue CPAP and 56 declined. One year later data
were available for 187 patients; 128 (68.5% on an intention to treat
analysis) continued to use the machine with a mean use of 5.0 (2.4) hours/night. A logistic regression model indicated that mean
CPAP use during the loan period and the overall satisfaction score
accurately defined continuing CPAP and "satisfactory" CPAP use at 1 year. For patients with low machine use and no symptomatic improvement
during the loan period, the addition of baseline AHI, baseline Epworth
score, and the Epworth score at the end of the loan to the equation
identifying factors associated with "satisfactory" CPAP use (mean
>2 hours/night) improved the value of the model.
CONCLUSIONData
derived from a 2 week CPAP trial are useful in identifying patients who
will comply with CPAP treatment to 1 year. It can be used to identify
patients with significant symptomatic disease who will struggle with
CPAP and may benefit from additional education and support. High mean
hourly use and a high degree of overall satisfaction during the loan
period identified patients likely to use CPAP and be compliant with it
at 1 year.
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