5 Steps to Improving CPAP Adherence

Christopher J. Lettieri, MD


March 06, 2012

In This Article

Assessing Patient Adherence

3. Assess adherence with therapy using a patient description of CPAP and objective measures of CPAP compliance (ie, adherence monitor “smart card” downloads).

Most newer CPAP devices have integrated adherence monitoring software, which records the absolute use of CPAP, the percentage of nights CPAP is used, and the number of hours CPAP is used per night. They also monitor for and record mask leaks and residual respiratory events, including flow limitations, obstructive apnea, and hypopnea and central apneic events.

A high residual apnea-hypopnea index, especially in patients reporting persistent sleep fragmentation or sleepiness, should prompt clinicians to reassess the prescribed CPAP pressures. This can be done by repeating an in-laboratory CPAP-titration study; however, repeated testing can frequently be avoided. Empirically increasing the set CPAP pressures by 2 cm H2O may resolve residual events and symptoms. However, increasing pressures may result in more mask leaks and more patient discomfort and may potentially precipitate central apnea. As such, a close clinical follow-up is recommended. Auto-adjusting/auto-titrating devices are being increasingly used for OSA. These devices self-adjust to reduce respiratory events. Residual events can be further eliminated by adjusting the set pressure range using data recorded by the device. A simple approach is to select the 90%-95% pressure (the device reports at what PAP pressure the patient spends 90%-95% of their sleep time) and make this the lower limit of the pressure range. The upper limit should be set at 2-4 cm H2O above this. Continued or worsened sleep quality or concerns for precipitation of central events should prompt a repeated in-laboratory titration study.


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