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CPAP Compliance Better When Titrations Include Sedatives

If you are administered sedatives during your titration sleep study, you have a better shot at long-term compliance after the study, a new study shows... thought this was of interest:

by David Douglas

Last Updated: 2009-11-16 16:34:05 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Giving sedatives during continuous positive airway pressure (CPAP) titration will improve patients' subsequent compliance, researchers report in the November issue of Chest.

"Obstructive sleep apnea is becoming increasingly prevalent," lead investigator Dr. Christopher J. Lettieri told Reuters Health. "CPAP remains the treatment of choice for most patients. Unfortunately many people are intolerant of CPAP initially because they find it uncomfortable or because they have a difficult time falling asleep with it on."

"Once they become accustomed to CPAP," he added, "their adherence is typically very good. However, many people discontinue the use of CPAP early on and never get to this point."

Dr. Lettieri and his colleagues at Walter Reed Army Medical Center, Washington DC randomized 117 patients to receive a 2-week course of 3 mg of eszopiclone or placebo during CPAP titration. Ninety-eight patients completed the study.

Eszopiclone produced significant improvements in mean sleep efficiency, total sleep time and the number of residual obstructive events seen at the final CPAP titration, compared to placebo.

Over the first 4 to 6 weeks, the active-treatment group showed significantly better compliance. They used CPAP on a higher percentage of nights (75.9% versus 60.1%) and for more hours per night (4.8 versus 3.9 hours).

Intent-to-treat analysis, which assumed that subjects who did not return for follow-up did not use CPAP at all, still showed a tendency toward greater compliance in the premedication group.

"Not only did they use it more, but less of them discontinued CPAP," Dr. Lettieri said.

"Given the prevalence of sleep apnea and the common difficulties patients have with CPAP, this and other interventions aimed at improving the initial experience with CPAP may help improve adherence," he concluded.

Chest 2009;136:1263-1268.
Copyright Reuters 2009.

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What I have trouble understanding is why in this day and age w/computers in so many homes and computer use required on so many jobs and therefore so many computer literate people in this country rather than getting anxious and in a twit when a sleep study is suggested or they have completed their sleep evaluation PSG and are awaiting their titration PSG WHY they don't get on the computer and look up OSA and polysomnography and end up in these forums and relieve so much of their anxiety.

My husband is one of "those" people who just does what the doctor says and doesn't question anything and drives me up a wall!!! I do NOT understand people so willnig and content to be so darn IGNORANT of their health condtions and treatment!!!!! My husband has a saying about some people: "He may not be dumb, but he sure is STUIPD!" meaning the person is educated, normal intelligence, etc., etc. but doesn't use his smarts and makes absolutely asinine decisions and mistakes. My husband is NOT dumb - but - when it comes to his medical care he is absolutely STUPID!!!!
This point may be supported
by research demonstrating that an increase in sleep efficiency
(SE) during CPAP titration compared to the diagnostic night
was found to be the only significant predictor of objectively
measured CPAP adherence after controlling for indices of OSA
severity and sleep quality during the diagnostic night. Specifically,
patients who had their SE increase used their machines an
average of 2 hours more per night than those who did not have
their SE increase.
I totally agree Judy.

I know there are several others that have sleep apnea where I teach. I have learned not to discuss it with them cause NOT one can tell you which machine they use, what their pressure is, etc. let alone monitor their therapy. It drives me nuts. How can they not care?
Ahh, SleepyCarol. Our local support group meetings ..... I honestly do NOT know WHY a good number of the members come to the meetings!!! Talk about not knowin' nuttin'!!!

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