Megan Brooks

June 19, 2012

June 19, 2012 (Boston, Massachusetts) — For patients resistant to positive airway pressure therapy (PAP), a "PAP-NAP" may boost compliance, a study suggests.

The PAP-NAP procedure is a relatively new offering in some sleep centers. It consists of a daytime PAP session lasting up to 2 hours, during which a technologist or therapist works 1-on-1 with the patient, addressing specific needs to enhance continuous PAP (CPAP) comfort and tolerability.

At SLEEP 2012: Associated Professional Sleep Societies 26th Annual Meeting, Jerald Simmons, MD, of Comprehensive Sleep Medicine Associates, Houston, Texas, and colleagues reported results of a retrospective study of 76 consecutive patients who underwent PAP-NAPs in their sleep centers. The sample included 35 men and 41 women who on average were 56 years old.

They say 95% of patients "successfully adapted" to CPAP by the end of the PAP-NAP session, although this rate dropped significantly over the first few weeks.

Nonetheless, clinicians say that PAP-NAP was able to "salvage" more than a third of patients reluctant to proceed to PAP therapy. Specifically, they say roughly 4 months after PAP-NAP, 29 patients (38%) had adequate CPAP compliance, which they defined as 4 or more hours per night. Twenty-six patients (34%) had partial CPAP compliance, and 21 patients (28%) failed CPAP therapy.

Researchers anticipate that "over longer follow-up intervals, some of our partial CPAP compliance group may improve to meet adequate CPAP compliance levels."

"With CPAP historically having a low long-term compliance rate, utilization of the PAP-NAP procedure is clearly necessary and beneficial to improve overall CPAP success," they write.

Promising Approach

Reached for comment on the study, Maryann Deak, MD, medical director for Sleep HealthCenters in Beverly, Massachusetts, noted that obstructive sleep apnea (OSA) leads to "a number of negative health consequences, and PAP remains the treatment of choice for OSA."

"There are several potential barriers to use of PAP therapy, including physiological and psychological factors, as well as co-morbid disorders," Dr. Deak told Medscape Medical News. "The PAP-NAP, while not a new concept, has not been extensively studied to date. However, it has real potential to improve patient comfort with PAP and thereby improve adherence to therapy."

"While the study was retrospective, it suggests that after a PAP-NAP, almost 40% of patients initially reluctant to proceed with PAP not only initiated therapy, but maintained good compliance 4 months later. This is a promising finding," Dr. Deak added.

The authors and Dr. Deak have disclosed no relevant financial relationships.

SLEEP 2012: Associated Professional Sleep Societies 26th Annual Meeting. Abstract 0406. Presented June 12, 2012.

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