REASONS OF DISCONTINUATION OF CPAP TREATMENT

IN PATIENTS WITH SAHS           

           

            C.Person, N.Meslier, L.Tome, C.Leménager, JL.Racineux.

            Unité de pathologie du sommeil.

            Service de Pneumologie,  CHU Angers.

 

To study the reasons of discontinuation of CPAP treatment, we compared 87 compliant patients and  42 patients who stopped their treatment.

The 87 compliant patients were patients seen on a follow up visit between 03/96 and 04/97, they were treated for  26+/-16 months. They had neither associated cardio-pulmonary disease nor psychotropic drug therapy.

The 42 non compliant patients either refused home treatment or stopped  CPAP after  6+/-5  months.

The initial evaluation included, for all patients, a standardized questionnaire evaluating symptoms and a polysomnography.

Nasal CPAP was instituted after the determination of the required CPAP pressure during a second polysomnography for all patients between 1992 and 1996.

The efficacy and the side effects are collected with questionnaires at the follow up visits for compliant patients.

Another questionnaire was mailed to the 92 patients who stopped  CPAP : 42 answers were analysable.

The comparison between the two groups showed that patients who abandonned their treatment were less overweighted, had less severe sleep apnea syndrome with a lower apnea index, a better sleep quality before treatment than compliant patients. The daytime sleepiness score was the same in the two groups.

During follow up, non compliant patients complained more often of symptoms of periodic legs movement and suffered from more important side effects.

The main reasons advocated to quit CPAP were intolerance of bedpartners (47,4 %), adverse effects (45,2%), and intolerance of the CPAP device by the patient himself (40,5 %).

 

Discontinuation of CPAP therapy is not related to the initial daytime sleepiness, but partly to the patients' weight, the sleep study variables and the tolerance of the bedpartner.