Langzeit-Compliance der CPAP-Therapie - aktueller Stand, Prädiktoren und Interventionsmöglichkeiten

Zusammenfassung

CPAP (continuous positive airway pressure) ist die Therapie der Wahl des obstruktiven Schlafapnoe-Syndroms (OSAS). Ca. 70 % der Patienten mit eingeleiteter CPAP-Therapie nutzen das Gerät dauerhaft während 70 % der Nächte für mindestens 4 Stunden pro Nacht. Prädiktoren für eine gute CPAP-Langzeitcompliance sind der Schweregrad der Atmungsstörung bzw. der Störung der Schlafarchitektur, der Ausprägungsgrad der Tagesmüdigkeit sowie die Patientenzufriedenheit mit dem diagnostischen und therapeutischen Procedere. Eine Steigerung der CPAP-Compliance ist durch intensive Patientenschulung zu erzielen. Apparative Alternativen zu CPAP wie z. B. Bilevel oder auto-CPAP-Systeme können die Langzeitcompliance nicht steigern.

Abstract

CPAP (continuous positive airway pressure) is the therapy of choice for obstructive sleep apnea syndrome (OSAS). About 70 % of patients on CPAP use their device for at least 70 % of nights with an application-time of at least 4 hours per night. Severity of breathing disorder respectively disturbance of sleep architecture, degree of daytime sleepiness and patients' satisfaction with diagnostic and therapeutic procedures are good predictors of long-term CPAP-compliance. CPAP-compliance can be increased by intensive patient education. Alternative devices like for example Bilevel or auto-CPAP respectively cannot augment CPAP compliance.

Literatur

• 1 Anstead M, Phillips B, Buch K. Tolerance and intolerance to continuous positive airway pressure.  Curr Opin Pulm Med. 1998;  4 351-354
• 2 Orth M, Rasche K, Ullrich H U. et al . Long-term compliance of n-CPAP therapy by patients with sleep related respiratory disorders.  Pneumologie. 1995;  49 (Suppl.1) 121-125
• 3 Rauscher H, Formanek D, Popp W. et al . Self-reported vs measured compliance with nasal CPAP for obstructive sleep apnea.  Chest. 1993;  103 1675-1680
• 4 Reeves-Hoché M K, Meck R, Zwillich C W. Nasal CPAP. An objective evaluation of patient compliance.  Am J Respir Crit Care Med. 1994;  149 149-154
• 5 Krieger J, Kurtz D, Petiau C. et al . Long-term compliance with CPAP therapy in obstructive sleep apnea patients and in snorers.  Sleep. 1996;  19 136-143
• 6 McArdle N, Devereux G, Heidarnejad H. et al . Long-term use of CPAP therapy for sleep apnea/hypopnea syndrome.  Am J Respir Crit Care Med. 1999;  159 1108-1114
• 7 Krieger J, Kurtz D, Petiau C. et al . Long-term compliance with CPAP therapy in obstructive sleep apnea patients and in snorers.  Sleep. 1996;  19 136-143
• 8 Sin D D, Mayers I, Man G CW. et al . Long-term compliance rates to continuous positive airways pressure in obstructive sleep apnea.  Chest. 2002;  121 430-435
• 9 Drake C L, Day R, Hudgel D. et al . Sleep during titration predicts continuous positive airway pressure compliance.  Sleep. 2003;  26 308-311
• 10 Krieger J, Sforza E, Petiau C. et al . Simplified diagnostic procedure for obstructive sleep apnoea syndrome: lower subsequent compliance with CPAP.  Eur Respir J. 1998;  12 776-779
• 11 Means M K, Edinger J D, Husain A. CPAP compliance in sleep apnea patients with and without laboratory titration.  Sleep and Breathing. 2004;  8 7-14
• 12 Ball E M, Banks M B. Determinants of compliance with nasal continuous positive airway pressure treatment applied in a community setting.  Sleep Medicine. 2001;  2 195-205
• 13 Popescu G, Latham M, Allgar V. et al . Continuous positive airway pressure for sleep apnoea/hypopnea syndrome: usefulness of a 2 week trial to identify factors associated with long term use.  Thorax. 2001;  56 727-733
• 14 Pelletier-Fleury N, Rakotonanahary D, Fleury B. The age and other factors in the evaluation of compliance with nasal continuous positive airway pressure for obstructive sleep apnea syndrome. A Cox's proportional hazard analysis.  Sleep Med. 2001;  2 225-232
• 15 Lewis K E, Seale L, Bartle I E. et al . Early predictors of CPAP use for the treatment of obstructive sleep apnea.  Sleep. 2004;  27 134-138
• 16 Chasens E R, Pack A I, Maislin G. et al . Claustrophobia and adherence to CPAP-treatment.  West J Nurs Res. 2005;  27 (3) 307-321
• 17 Haniffa M. et al .The Cochrane Library. Issue 3, http://www.thecochranelibrary.com 2005
• 18 Fletcher E C, Luckett R A. The effect of positive reinforcement on hourly compliance in nasal continuous positive airway pressure users with obstructive sleep apnea.  Am Rev Respir Dis. 1991;  143 936-941
• 19 Wiese H J, Boethel C, Phillips B. et al . CPAP compliance: video education may help!.  Sleep Medicine. 2005;  6 171-174
• 20 Aloia M S, Stanchina M, Arnedt J T. et al . Treatment adherence and outcomes in flexible vs standard continuous positive airway pressure therapy.  Chest. 2005;  127 2085-2093
• 21 Hoy C J, Vennelle M, Kingshott R N. et al . Can intensive support improve continuous positive airway pressure use in patients with the sleep apnea/hypopnea syndrome?.  Am J Respir Crit Care Med. 1999;  159 1096-1100
• 22 Chervin R D, Theut S, Bassetti C. et al . Compliance with nasal CPAP can be improved by simple interventions.  Sleep. 1997;  20 284-289
• 23 Khanna R, Kline L R. A prospective 8 week trial of nasal interfaces vs. a novel oral interface (Oracle) for treatment of obstructive sleep apnea hypopnea syndrome.  Sleep Med. 2003;  4 333-338
• 24 Massie C A, Hart R W. Clinical outcomes related to interface type in patients with obstructive sleep apnea/hypopnea syndrome who are using continuous positive airway pressure.  Chest. 2003;  123 1112-1118
• 25 Massie C A, Hart R W, Peralez K. et al . Effects of humidification on nasal symptoms and compliance in sleep apnea patients using continuous positive airway pressure.  Chest. 1999;  116 403-408
• 26 Mador M J, Krauza M, Pervez A. et al . Effect of heated humidification on compliance and quality of life in patients with sleep apnea using nasal continuous positive airway pressure.  Chest. 2005;  128 2151-2158
• 27 Ficker J H, Clarenbach C F, Neukirchner C. et al . Auto CPAP therapy based on the forced oscillation technique.  Biomed Technik. 2003;  48 68-72
• 28 Meurice J C, Marc I, Sériès F. Efficacy of auto-CPAP in the treatment of obstructive sleep apnea/hypopnea syndrome.  Am J Respir Crit Care Med. 1996;  153 794-798
• 29 Konermann M, Sanner B, Vyleta M. et al . Use of conventional and self-adjusting nasal continuous positive airway pressure for treatment of severe obstructive sleep apnea syndrome.  Chest. 1998;  113 714-718
• 30 Hukins C. Comparative study of autotitrating and fixed-pressure CPAP in the home: a randomized, single-blind crossover trial.  Sleep. 2004 Dec 15;  27(8) 1512-1517
• 31 Randerath W J, Schraeder O, Galetke W. et al . Autoadjusting CPAP therapy based on impedance. Efficacy, compliance and acceptance.  Am J Respir Crit Care Med. 2001;  163 652-657
• 32 d'Órtho M P, Grillier-Lanoir V, Lévy P. et al . Constant vs automatic continuous positive pressure therapy. Home evaluation.  Chest. 2000;  118 1010-1017
• 33 Hudgel D W, Fung C. A long-term randomized, cross-over comparison of auto titrating and standard nasal continuous airway pressure.  Sleep. 2000;  23 1-4
• 34 Massie C A, McArdle N, Hart R W. et al . Comparison between automatic and fixed positive airway pressure therapy in the home.  Am J Respir Crit Care Med. 2003;  167 20-23
• 35 Gay P C, Herold D L. A randomized, double-blind clinical trial comparing continuous positive airway pressure with a novel bilevel pressure system for treatment of obstructive sleep apnea syndrome.  Sleep. 2003;  26 864-869
• 36 Reeves-Hoché M K, Hudgel D W, Meck R. et al . Continuous versus bilevel positive airway pressure for obstructive sleep apnea.  Am J Respir Crit Care Med. 1995;  151 443-449
• 37 Doherty L S, Kiely J L, Swan V. et al . Long-term effects of nasal continuous positive airway pressure on cardiovascular outcomes in sleep apnea syndrome.  Chest. 2005;  127 2076-2084
• 38 Marin J M, Carrizo S J, Vicente E. et al . Long-term cardiovascular outcomes in men with obstructive sleep apnea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study.  Lancet. 2005;  365 1046-1053
• 39 Orth M, Duchna H W, Leidag M. et al . Driving simulator performance and neuropsychological testing in OSAS before and under CPAP.  Eur Respir J. 2005;  26 898-903
• 40 Rasche K, Orth M, Duchna H W. et al . CPAP therapy in obstructive sleep apnea syndrome. Side effects and acceptance in long-term follow-up.  Med Klin. 1994;  89 86-88
• 41 Waldhorn R E, Herrick T, Nguyen M C. et al . Long-term compliance with nasal continuous positive airway pressure therapy of obstructive sleep apnea.  Chest. 1990;  97 33-38
• 42 Akashiba T, Kurashina K, Sasaki I. et al . Long-term effects and complications of home nasal CPAP therapy for obstructive sleep apnea patients.  Nippon Kyobu Shikkan Gakkai Zasshi. 1992;  30 604-608
• 43 Pépin J L, Leger P, Veale D. et al . Side effects of nasal continuous positive airway pressure in sleep apnea syndrome. Study of 193 patients in two french Sleep Centers.  Chest. 1995;  107 375-381
• 44 Hoffstein V, Viner S, Mateika S. et al . Treatment of obstructive sleep apnea with nasal continuous positive airway pressure.  Am Rev Respir Dis. 1992;  145 841-845
• 45 Engleman H M, Asgari-Jirhandeh N, McLeod A L. et al . Self-reported use of CPAP and benefits of CPAP-therapy.  Chest. 1996;  109 1470-1476
• 46 Barnes M, Houston D, Worsnop C J. et al . A randomized controlled trial of continuous positive airway pressure in mild obstructive sleep apnea.  Am J Respir Crit Care Med. 2002;  165 773-780
• 47 Engleman H M, Martin S E, Douglas N J. Compliance with CPAP therapy in patients with the sleep apnoea/hypopnea syndrome.  Thorax. 1994;  49 263-266
• 48 Pépin J L, Krieger J L, Rodenstein D. et al . Effective compliance during the first 3 months of continuous positive airway pressure. A European prospective study of 121 patients.  Am J Respir Crit Care Med. 1999;  160 1124-1129
• 49 Hui D S, Choy D K, Li T S. et al . Determinants of continuous positive airway pressure compliance in a group of Chinese patients with obstructive sleep apnea.  Chest. 2001;  120 170-176
• 50 Meurice J C, Dore P, Paquereau J. et al . Predictive factors of long-term compliance with nasal continuous positive airway pressure treatment in sleep apnea syndrome.  Chest. 1994;  105 429-433