Treatment adherence and outcomes in flexible vs standard continuous positive airway pressure therapy.

Abstract

STUDY OBJECTIVES:

To compare adherence and clinical outcomes between flexible positive airway pressure (PAP) [C-Flex; Respironics; Murraysville, PA] and standard PAP therapy (ie, continuous positive airway pressure [CPAP]).

DESIGN AND SETTING:

A controlled clinical trial of CPAP therapy vs therapy using the C-Flex device in participants with moderate-to-severe obstructive sleep apnea. Participants were recruited from and followed up through an academic sleep disorders center.

PARTICIPANTS:

Eighty-nine participants were recruited into the study after they had undergone complete in-laboratory polysomnography and before initiating therapy. Participants received either therapy with CPAP (n = 41) or with the C-Flex device (n = 48), depending on the available treatment at the time of recruitment, with those recruited earlier receiving CPAP therapy and those recruited later receiving therapy with the C-Flex device. Follow-up assessments were conducted at 3 months.

MEASUREMENTS AND RESULTS:

The groups were similar demographically. The mean (+/- SD) treatment adherence over the 3-month follow-up period was higher in the C-Flex group compared to the CPAP group (weeks 2 to 4, 4.2 +/- 2.4 vs 3.5 +/- 2.8, respectively; weeks 9 to 12, 4.8 +/- 2.4 vs 3.1 +/- 2.8, respectively). Clinical outcomes and attitudes toward treatment (self-efficacy) were also measured. Change in subjective sleepiness and functional outcomes associated with sleep did not improve more in one group over the other. Self-efficacy showed a trend toward being higher at the follow-up in those patients who had been treated with the C-Flex device compared to CPAP treatment.

CONCLUSIONS:

Therapy with the C-Flex device may improve overall adherence over 3 months compared to standard therapy with CPAP. Clinical outcomes do not improve consistently, but C-Flex users may be more confident about their ability to adhere to treatment. Randomized clinical trials are needed to replicate these findings.

• Authors: Mark S Aloia, Michael Stanchina, J Todd Arnedt, Atul Malhotra, Richard P Millman
• Journal: Chest (Chest) Vol. 127 Issue 6 Pg. 2085-93 (Jun 2005) ISSN: 0012-3692 [Print] United States
• PMID: 15947324 (Publication Type: Clinical Trial, Comparative Study, Journal Article, Randomized Controlled Trial, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't, Research Support, U.S. Gov't, P.H.S.)

Topics

• Adult
• Age Factors
• Aged
• Aged, 80 and over
• Analysis of Variance
• Continuous Positive Airway Pressure (methods)
• Female
• Follow-Up Studies
• Humans
• Intermittent Positive-Pressure Ventilation (methods)
• Male
• Middle Aged
• Patient Compliance (statistics & numerical data)
• Polysomnography
• Probability
• Risk Assessment
• Sensitivity and Specificity
• Severity of Illness Index
• Sex Factors
• Sleep Apnea, Obstructive (diagnosis, therapy)
• Treatment Outcome