Importance of CPAP school. Improving treatment adherence

Introduction Gold standard treatment of obstructive sleep apneas (OSA) is with a Continuous positive airway pressure (CPAP) machine. Lack of adherence to CPAP is the major cause of treatment failure in OSA. Factors influencing CPAP acceptance are multi-factorial. One of the most important medical objectives is improving adherence. Objectives To determine whether installation of a CPAP device in a CPAP-school modifies final adherence, and analyze the factors associated with CPAP adherence at four months. Materials and methods Study undertaken at the Sleep Unit of a Tertiary University Hospital. All consecutive patients diagnosed with OSA that met indication for CPAP in a four month period were included. Anthropometric characteristics and baseline measures of disease severity were assessed. Subjects from another health area and those who had neurocognitive disorders or severe disease were excluded. Randomly, CPAP was installed at the CPAP school (intervention group) or at home (control group). The same protocol was used by the same group of selected nurses when installing the CPAP in both groups. CPAP adherence was assessed by memory cards in the machine. A multivariate linear regression model was built to determine factors associated with adherence. Results 166 patients were included; 49 of them were women (30%), mean age  = 53 ± 10 years, BMI  = 31 ± 3.4, and score on the Epworth scale  = 13 ± 2.6. Intervention group consisted of 81 patients and the control group of 85. Age, Epworth Sleepiness Scale, motivation, BMI and OSA severity were similar in both groups ( p  > 0.05). The intervention group had a higher number of patients with ⩽4 per hour rate ( p  = 0.047) and a lower number rejected CPAP ( p  = 0.001) than in the control group. In the treatment group the rate of use at the fourth month was about 4.8 ± 1.2 h while it was 3.7 ± 1.6 h ( p  = 0.001) in the control group. A multiple linear regression model showed that intervention and ratio in the first month were variables independently associated with treatment adherence. Four months adherence showed significant correlation with rate of use during first month, Epworth Score, apneas–hypopneas index and intensity of intermittent hypoxia. In multivariate linear regression model (R2  = 0.632; p  = 0.001) only ratio at first month and installation of device at CPAP-school were independent variables. Conclusion Ratio at first month and school CPAP are essential to increase CPAP adherence. This is relevant as school CPAP increases adherence over 1 h and decreases rejection of CPAP. Acknowledgement To Mrs. Inmaculada Jurado, a Linde nurse at CPAP school, for helping us to achieve this paper.