Long Term Use of Continuous Positive Airway Pressure

Covert objective monitoring of CPAP has demonstrated that adherence with nasal CPAP is substantially less than in studies where adherence is reported on the basis of subjective patient data (86), with only 46% of patients having used nasal CPAP equal to or greater than four hours for 70% of the observed nights. Adherence at one month predicted adherence at three months (86,91). Other studies have generally confirmed this degree of usage.

Published CPAP follow-up cohorts are biased by the same factors that affect clinical trials of pharmaceuticals. Patient populations are often highly selected for intellectual capacity, geographical access, health consciousness, and lack of comorbidities—all factors that may affect adherence in the real world. More large "open" studies from a variety of sleep clinics (92) would provide better information on true CPAP adherence.

Attempts to improve CPAP adherence have involved technical refinements of devices, including the implementation of microprocessor-controlled blowers, ramp features, integrated heated humidification, use of auto-CPAP, and adjunctive supportive measures. A flexible PAP device (see section: Pressure Level and Airflow) may prove advantageous for some patients (68). Video education at the outset may enhance CPAP usage and clinic attendance at one month postinitiation

A Cochrane review of interventions to improve CPAP adherence did not report a clear-cut advantage of increased hours of use in favor of auto-CPAP over fixed CPAP in pooled data of unselected patients though, where measured, patient preference was for auto-CPAP. In the same review, two of six studies of educational/ psychological interventions demonstrated improved hours of use (94).

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