New criteria for long-term CPAP therapy adherence in obstructive sleep apnea syndrome and arterial hypertension patients


DOI: https://dx.doi.org/10.18565/therapy.2022.5.26-38

Ovchinnikov Yu.V., Mostovoy L.V., Zaitsev A.A.

1) S.M. Kirov Military Medical Academy of the Ministry of Defense of the Russian Federation, Moscow; 2) Branch No. 8 of Academician N.N. Burdenko Main Military Clinical Hospital of the Ministry of Defense of the Russian Federation, Moscow Region, Khimki; 3) Academician N.N. Burdenko Main Military Clinical Hospital of the Ministry of Defense of the Russian Federation, Moscow
Abstract. Despite the high efficiency of CPAP therapy in the treatment of obstructive sleep apnea syndrome (OSAS), there are also quite serious problems with patients’ adherence to the long-term use of this method.
The aim of the study is to identify additional criteria for adherence to long-term CPAP therapy in patients with OSAS and arterial hypertension (AH).
Material and methods. The study included 260 patients with snoring, overweight and arterial hypertension. Research methods included the Epworth questionnaire, blood tests, echocardiography, and respiratory monitoring. Patients with diagnosed OSA of any degree were offered to undergo a trial course of CPAP therapy (132 patients agreed). The effectiveness of CPAP therapy was assessed using two developed visual scales. 1 year after discharge, the patients were divided into 3 groups depending on treatment adherence.
Results. Two additional criteria for adherence to long-term CPAP therapy were identified: subjective and objective. A subjective criterion of adherence to OSA is a difference of 4 or more points between visual scales after and before a test treatment of CPAP therapy. An objective criterion of adherence to OSAS is the simultaneous presence in a patient of 4 or 5 additional objective signs of adherence based on the results of respiratory monitoring: 1 – average SpO2 level ≤91,5%; 2 – minimal SpO2 against the background of apnea ≤74,5%; 3 – average duration of apnea ≥25,5 sec; 4 – maximum duration of apnea ≥56,5 sec; 5 – total duration of apnea ≥69,5 min. If the patient has only an objective criterion, adherence to CPAP therapy will be low (OR 0,58; CI: 0,19–1,78), if only a subjective criterion is identified, it will be moderate (OR 1,24; 95% CI: 1,09–1,42), and with the simultaneous presence of two criteria – very high (OR 20,4; 95% CI: 7,12–58,31).
Conclusion. When prescribing CPAP therapy to patients with OSAS and AH, it should be taken into account the adherence to this treatment method; long-term treatment should be recommended for patients having subjective and/or objective adherence criteria.
Keywords: CPAP therapy, adherence to treatment, obstructive sleep apnea syndrome, arterial hypertension
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Literature

1. Guilleminault C., Tilkian A., Dement W.C. The sleep apnea syndromes. Annu Rev Med. 1976; 27: 465–84.https://dx.doi.org/10.1146/annurev.me.27.020176.002341.


2. Peppard P.E., Young T., Palta M. et al. Longitudinal study of moderate weight change and sleep-disordered breathing. JAMA. 2000; 284(23): 3015–21. https://dx.doi.org/10.1001/jama.284.23.3015.


3. Kim J., Yi H., Shin K. R. et al. Snoring as an independent risk factor for hypertension in the nonobese population: the Korean Health and Genome Study. Am J Hypertens. 2007; 20(8): 819–24. https://dx.doi.org/10.1016/j.amjhyper.2007.03.007.


4. Senaratna C.V., Perret J.L., Lodge Caroline J. et al. Prevalence of obstructive sleep apnea in the general population: A systematic review. Sleep Med Rev. 2017; 34: 70–81. https://dx.doi.org/10.1016/j.smrv.2016.07.002.


5. Khokhrina A., Andreeva E., Degryse J.M. The prevalence of sleep-disordered breathing in Northwest Russia: The ARKHsleep study. Chron Respir Dis. 2020; 17: 1479973120928103. https://dx.doi.org/10.1177/1479973120928103.


6. Posadas T., Oscullo G., Zaldívar E. et al. Treatment with CPAP in elderly patients with obstructive sleep apnoea. J Clin Med. 2020; 9(2): 546. https://dx.doi.org/10.3390/jcm9020546.


7. Posadas T., Campos-Rodriguez F., Sapina-Beltran E. et al. Obstructive sleep apnea and arterial hypertension: implications of treatment adherence. Curr Hypertens Rep. 2020; 22(2): 12. https://dx.doi.org/10.1007/s11906-020-1015-y.


8. Patil S.P., Ayappa I.A., Caples S.M. et al. Treatment of adult obstructive sleep apnea with positive airway pressure: An American academy of sleep medicine systematic review, meta-analysis, and GRADE assessment. J Clin Sleep Med. 2019; 15(2): 301–34.https://dx.doi.org/10.5664/jcsm.7638.


9. McEvoy R.D., Antic N. A., Heeley E. et al. CPAP for prevention of cardiovascular events in obstructive sleep apnea. N Engl J Med. 2016; 375(10): 919–31. https://dx.doi.org/10.1056/NEJMoa1606599.


10. Woehrle H., Arzt M., Graml A. et al. Predictors of positive airway pressure therapy termination in the first year: analysis of big data from a German homecare provider. BMC Pulm Med. 2018; 18(1): 1–9. https://dx.doi.org/10.1186/s12890-018-0748-8.


11. Goyal A., Agarwal N., Pakhare A. Barriers to CPAP use in India: An exploratory study. J Clin Sleep Med. 2017; 13(12): 1385–94.https://dx.doi.org/10.5664/jcsm.6830;


12. Baratta F., Pastori D., Bucci T. et al. Long-term prediction of adherence to continuous positive air pressure therapy for the treatment of moderate/severe obstructive sleep apnea syndrome. Sleep Med. 2018; 43: 66–70. https://dx.doi.org/10.1016/j.sleep.2017.09.032.


13. Tsuyumu M., Tsurumoto T., Iimura J. et al. Ten-year adherence to continuous positive airway pressure treatment in patients with moderate-to-severe obstructive sleep apnea. Sleep Breath. 2020; 24(4): 1565–71. https://dx.doi.org/10.1007/s11325-020-02033-0.


14. Aalaei S., Rezaeitalab F., Tabesh H. et al. Factors affecting patients’ adherence to continuous positive airway pressure therapy for obstructive sleep apnea disorder: A multi-method approach. Iran J Med Sci. 2020; 45(3): 170–78.https://dx.doi.org/10.30476/ijms.2019.45785.


15. Nsair A., Hupin D., Chomette S. et al. Factors influencing adherence to auto-CPAP: An observational monocentric study comparing patients with and without cardiovascular diseases. Front Neurol. 2019; 10: 801. https://dx.doi.org/10.3389/fneur.2019.00801.


16. Salepci B., Caglayan B., Kiral N. et al. CPAP adherence of patients with obstructive sleep apnea. Respir Care. 2013; 58(9): 1467–73. https://dx.doi.org/10.4187/respcare.02139;


17. Jacobsen A.R., Eriksen F., Hansen R.W. et al. Determinants for adherence to continuous positive airway pressure therapy in obstructive sleep apnea. PLoS One. 2017; 12(12): e0189614. https://dx.doi.org/10.1371/journal.pone.0189614.


18. Muraki I., Wada H., Tanigawa T. Sleep apnea and type 2 diabetes. J Diabetes Investig. 2018; 9(5): 991–97.https://dx.doi.org/10.1111/jdi.12823.


19. Ioachimescu O.C., Janocko, N.J., Ciavatta M. et al. Comment on obstructive lung disease and obstructive sleep apnea (OLDOSA) cohort study: 10-year assessment. J Clin Sleep Med. 2020; 16(8): 1389. https://dx.doi.org/10.5664/jcsm.8480.


20. Cao W., Luo J., Xiao Y. A review of current tools used for evaluating the severity of obstructive sleep apnea. Nat Sci Sleep. 2020; 12: 1023–31. https://dx.doi.org/10.2147/NSS.S275252.


21. Rotenberg B.W., Murariu D., Pang K.P. Trends in CPAP adherence over twenty years of data collection: A flattened curve. J Otolaryngol Head Neck Surg. 2016; 45(1): 43. https://dx.doi.org/10.1186/s40463-016-0156-0;


22. Brostrom A., Pakpour А.H., Nilsen P. et al. Promoting CPAP adherence in clinical practice: A survey of Swedish and Norwegian CPAP practitioners’ beliefs and practices. J Sleep Res. 2018; 27(6): e12675. https://dx.doi.org/10.1111/jsr.12675.


About the Autors

Yuri V. Ovchinnikov, Dr. med. habil., professor, professor of Department of Emergency Medicine, branch of S.M. Kirov Military Medical Academy of the Ministry of Defense of the Russian Federation, Honored Doctor of the Russian Federation. Address: 107392, Moscow, 7 Malaya Cherkizovskaya Str. E-mail: ovchinnikov.munkc@mail.ru.
ORCID: https://orcid.org/0000-0003-1843-087X
Leonid V. Mostovoy, pulmonologist, senior resident of the Department of pulmonology, branch No. 8 of Academician N.N. Burdenko Main Military Clinical Hospital of the Ministry of Defense of the Russian Federation. Address: 141408, Moscow Region, Khimki City District, microdistrict Planernaya, possession 14. E-mail: leonidmost1984@gmail.com. ORCID: https://orcid.org/0000-0002-4326-0043
Andrey A. Zaitsev, Dr. med. habil., professor, chief pulmonologist of Academician N.N. Burdenko Main Military Clinical Hospital of the Ministry of Defense of the Russian Federation, chief pulmonologist of the Ministry of Defense of the Russian Federation. Address: 105229, Moscow, 3 Gospital`naya Sq. E-mail: a-zaicev@yandex.ru.
ORCID: https://orcid.org/0000-0002-0934-7313


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