Prescription Medications May Do Little to Encourage CPAP Use

This study provides evidence that, contrary to popular practice, prescription medications that help patients to fall sleep may not improve compliance with nocturnal CPAP and possibly other devices used in the treatment of OSA, said Mark J. Rosen, MD, Chief of the Divisions of Pulmonary, Critical Care and Sleep Medicine at North Shore University Hospital and Long Island Jewish Medical Center in New York. Of course, it should be confirmed by larger studies, and perhaps using different drugs to validate this finding, to see if it is true across all of these medications.

Careful questioning about why a patient is unable to use CPAP can help you to identify other potential treatments to improve CPAP tolerance, said Dr. Kezirian. These may include behavioral measures (weight loss, lateral versus supine sleep position, no alcohol or sedatives at nighttime), surgery or oral appliances.

There are many factors to consider when determining the best treatment for OSA, added Dr. Kezirian. OSA severity and patient-related matters, such as age, medical problems, anatomy and utilization all enter into a patient’s decision to proceed with a specific, effective treatment plan.

Practice Parameters for Using CPAP and BiPAP

• A diagnosis of OSA must be established by an acceptable method.
• CPAP is effective for treating OSA.
• Full-night, attended studies performed in the laboratory are the preferred approach for titration to determine optimal pressure; however, split-night, diagnostic-titration studies are usually adequate.
• CPAP usage should be monitored objectively to help assure utilization.
• Initial CPAP follow-up is recommended during the first few weeks to establish utilization pattern and provide remediation, if needed.
• Longer-term follow-up is recommended yearly or as needed to address mask, machine or usage problems.
• Heated humidification and systematic educational programs are recommended to improve CPAP utilization.
• Some functional outcomes, such as subjective sleepiness, improve with positive pressure treatment in patients with OSA.
• CPAP and BiPAP therapy are safe; side effects and adverse events are mainly minor and reversible.
• BiPAP may be useful in treating some forms of restrictive lung disease or hypoventilation syndromes associated with hypercapnia.

Source: American Academy of Sleep Medicine. www.aasmnet.org /PDF/PP_PostiveAirwayPressure.pdf

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