Download PDF
Semin Respir Crit Care Med 2014; 35(05): 604-612
DOI: 10.1055/s-0034-1390070
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Enhancing Adherence to Positive Airway Pressure Therapy for Sleep Disordered Breathing

Tonya Russell
1   Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, Saint Louis, Missouri
› Author Affiliations
Further Information

Publication History

Publication Date:
29 October 2014 (online)

    Permissions and Reprints

Abstract

Sleep disordered breathing is made up of a group of conditions that include obstructive sleep apnea, central sleep apnea, complex sleep apnea, and sleep-related hypoventilation. Continuous positive airway pressure (CPAP) is the first-line therapy for obstructive sleep apnea. The other forms of sleep disordered breathing require different types of positive airway pressure (PAP). Adherence to PAP can be challenging and affected by multiple factors. Educating the patient regarding the consequences of untreated sleep disordered breathing and the benefits of PAP is the first step in improving adherence. Attention to social, psychological, and demographic factors that may contribute to difficulty complying is important. Addressing side effects such as nasal symptoms and equipment usability issues is also beneficial. Compliance can be monitored by the data download cards present in PAP machines, but clinicians must be aware of the limitations of the data obtained. The challenges of improving adherence occur along with the increasing need to demonstrate to payers a patient's adherence to and benefit from PAP therapy.

Keywords

positive airway pressure therapy - adherence - compliance - obstructive sleep apnea - sleep disordered breathing
 

  • References

  • 1 Kryger MH. Sleep apnea: From the needles of Dionysius to continuous positive airway pressure. Arch Intern Med 1983; 143 (12) 2301-2303
    CrossrefPubMedGoogle Scholar
  • 2 Bickelmann AG, Burwell CS, Robin ED, Whaley RD. Extreme obesity associated with alveolar hypoventilation; a Pickwickian syndrome. Am J Med 1956; 21 (5) 811-818
    CrossrefPubMedGoogle Scholar
  • 3 Jung R, Kuhlo W. Neurophysiological studies of abnormal night sleep and the Pickwickian syndrome. Prog Brain Res 1965; 18: 140-159
    PubMedGoogle Scholar
  • 4 Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 1993; 328 (17) 1230-1235
    Google Scholar
  • 5 Overweight and Obesity – Data and Statistics. www.cdc.gov/obesity
    PubMedGoogle Scholar
  • 6 Peppard PE, Young T, Palta M, Skatrud J. Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med 2000; 342 (19) 1378-1384
    Google Scholar
  • 7 Nieto FJ, Young TB, Lind BK , et al. Association of sleep-disordered breathing, sleep apnea, and hypertension in a large community-based study. Sleep Heart Health Study. JAMA 2000; 283 (14) 1829-1836
    CrossrefPubMedGoogle Scholar
  • 8 Shahar E, Whitney CW, Redline S , et al. Sleep-disordered breathing and cardiovascular disease: cross-sectional results of the Sleep Heart Health Study. Am J Respir Crit Care Med 2001; 163 (1) 19-25
    CrossrefPubMedGoogle Scholar
  • 9 Logan AG, Perlikowski SM, Mente A , et al. High prevalence of unrecognized sleep apnoea in drug-resistant hypertension. J Hypertens 2001; 19 (12) 2271-2277
    CrossrefPubMedGoogle Scholar
  • 10 Marin JM, Carrizo SJ, Vicente E, Agusti AGN. Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study. Lancet 2005; 365 (9464) 1046-1053
    CrossrefPubMedGoogle Scholar
  • 11 Yaggi HK, Concato J, Kernan WN, Lichtman JH, Brass LM, Mohsenin V. Obstructive sleep apnea as a risk factor for stroke and death. N Engl J Med 2005; 353 (19) 2034-2041
    CrossrefPubMedGoogle Scholar
  • 12 Barbé F, Sunyer J, de la Peña A , et al. Effect of continuous positive airway pressure on the risk of road accidents in sleep apnea patients. Respiration 2007; 74 (1) 44-49
    CrossrefPubMedGoogle Scholar
  • 13 Mulgrew AT, Nasvadi G, Butt A , et al. Risk and severity of motor vehicle crashes in patients with obstructive sleep apnoea/hypopnoea. Thorax 2008; 63 (6) 536-541
    CrossrefPubMedGoogle Scholar
  • 14 Sassani A, Findley LJ, Kryger M, Goldlust E, George C, Davidson TM. Reducing motor-vehicle collisions, costs, and fatalities by treating obstructive sleep apnea syndrome. Sleep 2004; 27 (3) 453-458
    PubMedGoogle Scholar
  • 15 Sullivan CE, Issa FG, Berthon-Jones M, Eves L. Reversal of obstructive sleep apnoea by continuous positive airway pressure applied through the nares. Lancet 1981; 1 (8225) 862-865
    PubMedGoogle Scholar
  • 16 Becker HF, Jerrentrup A, Ploch T , et al. Effect of nasal continuous positive airway pressure treatment on blood pressure in patients with obstructive sleep apnea. Circulation 2003; 107 (1) 68-73
    CrossrefPubMedGoogle Scholar
  • 17 Milleron O, Pillière R, Foucher A , et al. Benefits of obstructive sleep apnoea treatment in coronary artery disease: a long-term follow-up study. Eur Heart J 2004; 25 (9) 728-734
    CrossrefPubMedGoogle Scholar
  • 18 Dhillon S, Chung SA, Fargher T, Huterer N, Shapiro CM. Sleep apnea, hypertension, and the effects of continuous positive airway pressure. Am J Hypertens 2005; 18 (5, Pt 1) 594-600
    CrossrefPubMedGoogle Scholar
  • 19 Peker Y, Carlson J, Hedner J. Increased incidence of coronary artery disease in sleep apnoea: a long-term follow-up. Eur Respir J 2006; 28 (3) 596-602
    CrossrefPubMedGoogle Scholar
  • 20 Kapur V, Blough DK, Sandblom RE , et al. The medical cost of undiagnosed sleep apnea. Sleep 1999; 22 (6) 749-755
    PubMedGoogle Scholar
  • 21 Albarrak M, Banno K, Sabbagh AA , et al. Utilization of healthcare resources in obstructive sleep apnea syndrome: a 5-year follow-up study in men using CPAP. Sleep 2005; 28 (10) 1306-1311
    PubMedGoogle Scholar
  • 22 Weaver TE, Maislin G, Dinges DF , et al. Relationship between hours of CPAP use and achieving normal levels of sleepiness and daily functioning. Sleep 2007; 30 (6) 711-719
    PubMedGoogle Scholar
  • 23 Hoffstein V, Viner S, Mateika S, Conway J. Treatment of obstructive sleep apnea with nasal continuous positive airway pressure. Patient compliance, perception of benefits, and side effects. Am Rev Respir Dis 1992; 145 (4, Pt 1) 841-845
    CrossrefPubMedGoogle Scholar
  • 24 McArdle N, Devereux G, Heidarnejad H, Engleman HM, Mackay TW, Douglas NJ. Long-term use of CPAP therapy for sleep apnea/hypopnea syndrome. Am J Respir Crit Care Med 1999; 159 (4, Pt 1) 1108-1114
    CrossrefPubMedGoogle Scholar
  • 25 Sin DD, Mayers I, Man GCW, Pawluk L. Long-term compliance rates to continuous positive airway pressure in obstructive sleep apnea: a population-based study. Chest 2002; 121 (2) 430-435
    CrossrefPubMedGoogle Scholar
  • 26 Weaver TE, Grunstein RR. Adherence to continuous positive airway pressure therapy: the challenge to effective treatment. Proc Am Thorac Soc 2008; 5 (2) 173-178
    CrossrefPubMedGoogle Scholar
  • 27 Yetkin O, Kunter E, Gunen H. CPAP compliance in patients with obstructive sleep apnea syndrome. Sleep Breath 2008; 12 (4) 365-367
    CrossrefPubMedGoogle Scholar
  • 28 Balachandran JS, Yu X, Wroblewski K, Mokhlesi B. A brief survey of patients' first impression after CPAP titration predicts future CPAP adherence: a pilot study. J Clin Sleep Med 2013; 9 (3) 199-205
    PubMedGoogle Scholar
  • 29 Furukawa T, Suzuki M, Ochiai M, Kawashima H, Yokoyama N, Isshiki T. Long-term adherence to nasal continuous positive airway pressure therapy by hypertensive patients with preexisting sleep apnea. J Cardiol 2014; 63 (4) 281-285
    CrossrefPubMedGoogle Scholar
  • 30 Campos-Rodriguez F, Martinez-Garcia MA, Reyes-Nuñez N , et al. Long-term continuous positive airway pressure compliance in females with obstructive sleep apnoea. Eur Respir J 2013; 42 (5) 1255-1262
    CrossrefPubMedGoogle Scholar
  • 31 Kim H, Kim MS, Lee JE , et al. Treatment outcomes and compliance according to obesity in patients with obstructive sleep apnea. Eur Arch Otorhinolaryngol 2013; 270 (11) 2885-2890
    CrossrefPubMedGoogle Scholar
  • 32 Borel JC, Tamisier R, Dias-Domingos S , et al; Scientific Council of The Sleep Registry of the French Federation of Pneumology (OSFP). Type of mask may impact on continuous positive airway pressure adherence in apneic patients. PLoS ONE 2013; 8 (5) e64382
    CrossrefPubMedGoogle Scholar
  • 33 Kohler M, Smith D, Tippett V, Stradling JR. Predictors of long-term compliance with continuous positive airway pressure. Thorax 2010; 65 (9) 829-832
    CrossrefPubMedGoogle Scholar
  • 34 Gagnadoux F, Le Vaillant M, Goupil F , et al; IRSR sleep cohort group. Influence of marital status and employment status on long-term adherence with continuous positive airway pressure in sleep apnea patients. PLoS ONE 2011; 6 (8) e22503
    CrossrefPubMedGoogle Scholar
  • 35 Wild MR, Engleman HM, Douglas NJ, Espie CA. Can psychological factors help us to determine adherence to CPAP? A prospective study. Eur Respir J 2004; 24 (3) 461-465
    CrossrefPubMedGoogle Scholar
  • 36 Skinner T, McNeil L, Olaithe M , et al. Predicting uptake of continuous positive airway pressure (CPAP) therapy in obstructive sleep apnoea (OSA): a belief-based theoretical approach. Sleep Breath 2013; 17 (4) 1229-1240
    CrossrefPubMedGoogle Scholar
  • 37 Aloia MS, Arnedt JT, Stepnowsky C, Hecht J, Borrelli B. Predicting treatment adherence in obstructive sleep apnea using principles of behavior change. J Clin Sleep Med 2005; 1 (4) 346-353
    PubMedGoogle Scholar
  • 38 Hoy CJ, Vennelle M, Kingshott RN, Engleman HM, Douglas NJ. 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 (4 Pt 1) 1096-1100
    CrossrefPubMedGoogle Scholar
  • 39 Poulet C, Veale D, Arnol N, Lévy P, Pepin JL, Tyrrell J. Psychological variables as predictors of adherence to treatment by continuous positive airway pressure. Sleep Med 2009; 10 (9) 993-999
    CrossrefPubMedGoogle Scholar
  • 40 Lewis KE, Seale L, Bartle IE, Watkins AJ, Ebden P. Early predictors of CPAP use for the treatment of obstructive sleep apnea. Sleep 2004; 27 (1) 134-138
    Google Scholar
  • 41 Pamidi S, Knutson KL, Ghods F, Mokhlesi B. The impact of sleep consultation prior to a diagnostic polysomnogram on continuous positive airway pressure adherence. Chest 2012; 141 (1) 51-57
    CrossrefPubMedGoogle Scholar
  • 42 Falcone VA, Damiani MF, Quaranta VN, Capozzolo A, Resta O. Polysomnograph chart view by patients: a new educational strategy to improve CPAP adherence in sleep apnea therapy. Respir Care 2014; 59 (2) 193-198
    CrossrefPubMedGoogle Scholar
  • 43 Parthasarathy S, Wendel C, Haynes PL, Atwood C, Kuna S. A pilot study of CPAP adherence promotion by peer buddies with sleep apnea. J Clin Sleep Med 2013; 9 (6) 543-550
    PubMedGoogle Scholar
  • 44 DeMolles DA, Sparrow D, Gottlieb DJ, Friedman R. A pilot trial of a telecommunications system in sleep apnea management. Med Care 2004; 42 (8) 764-769
    CrossrefPubMedGoogle Scholar
  • 45 Sparrow D, Aloia M, Demolles DA, Gottlieb DJ. A telemedicine intervention to improve adherence to continuous positive airway pressure: a randomised controlled trial. Thorax 2010; 65 (12) 1061-1066
    CrossrefPubMedGoogle Scholar
  • 46 Cartwright RD, Knight S. Silent partners: the wives of sleep apneic patients. Sleep 1987; 10 (3) 244-248
    PubMedGoogle Scholar
  • 47 Kiely JL, McNicholas WT. Bed partners' assessment of nasal continuous positive airway pressure therapy in obstructive sleep apnea. Chest 1997; 111 (5) 1261-1265
    CrossrefPubMedGoogle Scholar
  • 48 Parish JM, Lyng PJ. Quality of life in bed partners of patients with obstructive sleep apnea or hypopnea after treatment with continuous positive airway pressure. Chest 2003; 124 (3) 942-947
    CrossrefPubMedGoogle Scholar
  • 49 McArdle N, Kingshott R, Engleman HM, Mackay TW, Douglas NJ. Partners of patients with sleep apnoea/hypopnoea syndrome: effect of CPAP treatment on sleep quality and quality of life. Thorax 2001; 56 (7) 513-518
    CrossrefPubMedGoogle Scholar
  • 50 Weaver TE, Maislin G, Dinges DF , et al. Self-efficacy in sleep apnea: instrument development and patient perceptions of obstructive sleep apnea risk, treatment benefit, and volition to use continuous positive airway pressure. Sleep 2003; 26 (6) 727-732
    PubMedGoogle Scholar
  • 51 Ye L, Pack AI, Maislin G , et al. Predictors of continuous positive airway pressure use during the first week of treatment. J Sleep Res 2012; 21 (4) 419-426
    CrossrefPubMedGoogle Scholar
  • 52 Mortimore IL, Whittle AT, Douglas NJ. Comparison of nose and face mask CPAP therapy for sleep apnoea. Thorax 1998; 53 (4) 290-292
    CrossrefPubMedGoogle Scholar
  • 53 Teo M, Amis T, Lee S, Falland K, Lambert S, Wheatley J. Equivalence of nasal and oronasal masks during initial CPAP titration for obstructive sleep apnea syndrome. Sleep 2011; 34 (7) 951-955
    CrossrefPubMedGoogle Scholar
  • 54 Bakker JP, Neill AM, Campbell AJ. Nasal versus oronasal continuous positive airway pressure masks for obstructive sleep apnea: a pilot investigation of pressure requirement, residual disease, and leak. Sleep Breath 2012; 16 (3) 709-716
    CrossrefPubMedGoogle Scholar
  • 55 Montesi SB, Bakker JP, Macdonald M , et al. Air leak during CPAP titration as a risk factor for central apnea. J Clin Sleep Med 2013; 9 (11) 1187-1191
    PubMedGoogle Scholar
  • 56 Massie CA, Hart RW. Clinical outcomes related to interface type in patients with obstructive sleep apnea/hypopnea syndrome who are using continuous positive airway pressure. Chest 2003; 123 (4) 1112-1118
    CrossrefPubMedGoogle Scholar
  • 57 Ryan S, Garvey JF, Swan V, Behan R, McNicholas WT. Nasal pillows as an alternative interface in patients with obstructive sleep apnoea syndrome initiating continuous positive airway pressure therapy. J Sleep Res 2011; 20 (2) 367-373
    CrossrefPubMedGoogle Scholar
  • 58 Zhu X, Wimms AJ, Benjafield AV. Assessment of the performance of nasal pillows at high CPAP pressures. J Clin Sleep Med 2013; 9 (9) 873-877
    PubMedGoogle Scholar
  • 59 Chasens ER, Pack AI, Maislin G, Dinges DF, Weaver TE. Claustrophobia and adherence to CPAP treatment. West J Nurs Res 2005; 27 (3) 307-321
    CrossrefPubMedGoogle Scholar
  • 60 Edinger JD, Radtke RA. Use of in vivo desensitization to treat a patient's claustrophobic response to nasal CPAP. Sleep 1993; 16 (7) 678-680
    PubMedGoogle Scholar
  • 61 Fung CH, Martin JL, Igodan U, Jouldjian S, Alessi C. The association between difficulty using positive airway pressure equipment and adherence to therapy: a pilot study. Sleep Breath 2013; 17 (2) 853-859
    CrossrefPubMedGoogle Scholar
  • 62 Massie CA, Hart RW, Peralez K, Richards GN. Effects of humidification on nasal symptoms and compliance in sleep apnea patients using continuous positive airway pressure. Chest 1999; 116 (2) 403-408
    CrossrefPubMedGoogle Scholar
  • 63 Strobel W, Schlageter M, Andersson M , et al. Topical nasal steroid treatment does not improve CPAP compliance in unselected patients with OSAS. Respir Med 2011; 105 (2) 310-315
    CrossrefPubMedGoogle Scholar
  • 64 Ryan S, Doherty LS, Nolan GM, McNicholas WT. Effects of heated humidification and topical steroids on compliance, nasal symptoms, and quality of life in patients with obstructive sleep apnea syndrome using nasal continuous positive airway pressure. J Clin Sleep Med 2009; 5 (5) 422-427
    PubMedGoogle Scholar
  • 65 Poirier J, George C, Rotenberg B. The effect of nasal surgery on nasal continuous positive airway pressure compliance. Laryngoscope 2014; 124 (1) 317-319
    CrossrefPubMedGoogle Scholar
  • 66 Wickwire EM, Smith MT, Birnbaum S, Collop NA. Sleep maintenance insomnia complaints predict poor CPAP adherence: A clinical case series. Sleep Med 2010; 11 (8) 772-776
    CrossrefPubMedGoogle Scholar
  • 67 Björnsdóttir E, Janson C, Sigurdsson JF , et al. Symptoms of insomnia among patients with obstructive sleep apnea before and after two years of positive airway pressure treatment. Sleep 2013; 36 (12) 1901-1909
    PubMedGoogle Scholar
  • 68 Roux FJ. Restless legs syndrome: impact on sleep-related breathing disorders. Respirology 2013; 18 (2) 238-245
    CrossrefPubMedGoogle Scholar
  • 69 Delgado Rodrigues RN, Alvim de Abreu E Silva Rodrigues AA, Pratesi R, Krieger J. Outcome of restless legs severity after continuous positive air pressure (CPAP) treatment in patients affected by the association of RLS and obstructive sleep apneas. Sleep Med 2006; 7 (3) 235-239
    CrossrefPubMedGoogle Scholar
  • 70 Rodrigues RN, Abreu e Silva Rodrigues AA, Pratesi R , et al. Outcome of sleepiness and fatigue scores in obstructive sleep apnea syndrome patients with and without restless legs syndrome after nasal CPAP. Arq Neuropsiquiatr 2007; 65 (1) 54-58
    CrossrefPubMedGoogle Scholar
  • 71 Javaheri S, Smith J, Chung E. The prevalence and natural history of complex sleep apnea. J Clin Sleep Med 2009; 5 (3) 205-211
    PubMedGoogle Scholar
  • 72 Kuzniar TJ, Patel S, Nierodzik CL, Smith LC. Comparison of two servo ventilator devices in the treatment of complex sleep apnea. Sleep Med 2011; 12 (6) 538-541
    CrossrefPubMedGoogle Scholar
  • 73 Kuźniar TJ, Morgenthaler TI. Treatment of complex sleep apnea syndrome. Chest 2012; 142 (4) 1049-1057
    CrossrefPubMedGoogle Scholar
  • 74 Ayas NT, Patel SR, Malhotra A , et al. Auto-titrating versus standard continuous positive airway pressure for the treatment of obstructive sleep apnea: results of a meta-analysis. Sleep 2004; 27 (2) 249-253
    Google Scholar
  • 75 Karasulu L, Epöztürk PÖ, Sökücü SN, Dalar L, Altin S. Improving Heart rate variability in sleep apnea patients: differences in treatment with auto-titrating positive airway pressure (APAP) versus conventional CPAP. Lung 2010; 188 (4) 315-320
    CrossrefPubMedGoogle Scholar
  • 76 Dolan DC, Okonkwo R, Gfullner F, Hansbrough JR, Strobel RJ, Rosenthal L. Longitudinal comparison study of pressure relief (C-Flex) vs. CPAP in OSA patients. Sleep Breath 2009; 13 (1) 73-77
    CrossrefPubMedGoogle Scholar
  • 77 Bakker J, Campbell A, Neill A. Randomized controlled trial comparing flexible and continuous positive airway pressure delivery: effects on compliance, objective and subjective sleepiness and vigilance. Sleep 2010; 33 (4) 523-529
    PubMedGoogle Scholar
  • 78 Nilius G, Happel A, Domanski U, Ruhle KH. Pressure-relief continuous positive airway pressure vs constant continuous positive airway pressure: a comparison of efficacy and compliance. Chest 2006; 130 (4) 1018-1024
    CrossrefPubMedGoogle Scholar
  • 79 Aloia MS, Stanchina M, Arnedt JT, Malhotra A, Millman RP. Treatment adherence and outcomes in flexible vs standard continuous positive airway pressure therapy. Chest 2005; 127 (6) 2085-2093
    CrossrefPubMedGoogle Scholar
  • 80 Marshall NS, Neill AM, Campbell AJ. Randomised trial of compliance with flexible (C-Flex) and standard continuous positive airway pressure for severe obstructive sleep apnea. Sleep Breath 2008; 12 (4) 393-396
    CrossrefPubMedGoogle Scholar
  • 81 Schäfer H, Ewig S, Hasper E, Lüderitz B. Failure of CPAP therapy in obstructive sleep apnoea syndrome: predictive factors and treatment with bilevel-positive airway pressure. Respir Med 1998; 92 (2) 208-215
    CrossrefPubMedGoogle Scholar
  • 82 Resta O, Guido P, Picca V , et al. Prescription of nCPAP and nBIPAP in obstructive sleep apnoea syndrome: Italian experience in 105 subjects. A prospective two centre study. Respir Med 1998; 92 (6) 820-827
    CrossrefPubMedGoogle Scholar
  • 83 Schwartz SW, Rosas J, Iannacone MR, Foulis PR, Anderson WM. Correlates of a prescription for Bilevel positive airway pressure for treatment of obstructive sleep apnea among veterans. J Clin Sleep Med 2013; 9 (4) 327-335
    PubMedGoogle Scholar
  • 84 Mokhlesi B, Tulaimat A, Faibussowitsch I, Wang Y, Evans AT. Obesity hypoventilation syndrome: prevalence and predictors in patients with obstructive sleep apnea. Sleep Breath 2007; 11 (2) 117-124
    CrossrefPubMedGoogle Scholar
  • 85 Nowbar S, Burkart KM, Gonzales R , et al. Obesity-associated hypoventilation in hospitalized patients: prevalence, effects, and outcome. Am J Med 2004; 116 (1) 1-7
    CrossrefPubMedGoogle Scholar
  • 86 Kushida CA, Chediak A, Berry RB , et al; Positive Airway Pressure Titration Task Force; American Academy of Sleep Medicine. Clinical guidelines for the manual titration of positive airway pressure in patients with obstructive sleep apnea. J Clin Sleep Med 2008; 4 (2) 157-171
    PubMedGoogle Scholar
  • 87 Lettieri CJ, Collen JF, Eliasson AH, Quast TM. Sedative use during continuous positive airway pressure titration improves subsequent compliance: a randomized, double-blind, placebo-controlled trial. Chest 2009; 136 (5) 1263-1268
    CrossrefPubMedGoogle Scholar
  • 88 Park JG, Olson EJ, Morgenthaler TI. Impact of zaleplon on continuous positive airway pressure therapy compliance. J Clin Sleep Med 2013; 9 (5) 439-444
    PubMedGoogle Scholar
  • 89 Lettieri CJ, Shah AA, Holley AB, Kelly WF, Chang AS, Roop SA. CPAP Promotion and Prognosis-The Army Sleep Apnea Program Trial. Effects of a short course of eszopiclone on continuous positive airway pressure adherence: a randomized trial. Ann Intern Med 2009; 151 (10) 696-702
    CrossrefPubMedGoogle Scholar
  • 90 Bradshaw DA, Ruff GA, Murphy DP. An oral hypnotic medication does not improve continuous positive airway pressure compliance in men with obstructive sleep apnea. Chest 2006; 130 (5) 1369-1376
    CrossrefPubMedGoogle Scholar
  • 91 Zhang XJ, Li QY, Wang Y, Xu HJ, Lin YN. The effect of non-benzodiazepine hypnotics on sleep quality and severity in patients with OSA: a meta-analysis. Sleep Breath 2014; ; DOI: 10.1007/s11325-014-0943-7
    PubMedGoogle Scholar
  • 92 Lu B, Budhiraja R, Parthasarathy S. Sedating medications and undiagnosed obstructive sleep apnea: physician determinants and patient consequences. J Clin Sleep Med 2005; 1 (4) 367-371
    PubMedGoogle Scholar
  • 93 Rauscher H, Formanek D, Popp W, Zwick H. Self-reported vs measured compliance with nasal CPAP for obstructive sleep apnea. Chest 1993; 103 (6) 1675-1680
    CrossrefPubMedGoogle Scholar
  • 94 Schwab RJ, Badr SM, Epstein LJ , et al; ATS Subcommittee on CPAP Adherence Tracking Systems. An official American Thoracic Society statement: continuous positive airway pressure adherence tracking systems. The optimal monitoring strategies and outcome measures in adults. Am J Respir Crit Care Med 2013; 188 (5) 613-620
    Google Scholar
  • 95 Stepnowsky CJ, Palau JJ, Marler MR, Gifford AL. Pilot randomized trial of the effect of wireless telemonitoring on compliance and treatment efficacy in obstructive sleep apnea. J Med Internet Res 2007; 9 (2) e14
    PubMedGoogle Scholar
  • 96 Fox N, Hirsch-Allen AJ, Goodfellow E , et al. The impact of a telemedicine monitoring system on positive airway pressure adherence in patients with obstructive sleep apnea: a randomized controlled trial. Sleep 2012; 35 (4) 477-481
    PubMedGoogle Scholar
  • 97 Ballard RD, Gay PC, Strollo PJ. Interventions to improve compliance in sleep apnea patients previously non-compliant with continuous positive airway pressure. J Clin Sleep Med 2007; 3 (7) 706-712
    PubMedGoogle Scholar
  • 98 Damjanovic D, Fluck A, Bremer H, Müller-Quernheim J, Idzko M, Sorichter S. Compliance in sleep apnoea therapy: influence of home care support and pressure mode. Eur Respir J 2009; 33 (4) 804-811
    CrossrefPubMedGoogle Scholar