Continuous positive airway pressure therapy in multidisciplinary treatment

Abstract

We studied the acceptability of nasal continuous positive airway pressure (CPAP) therapy in 74 patients with obstructive sleep apnea-hypopnea (OSAH). CPAP was conducted in multidisciplinary treatment, combined with surgery and oral appliances. OSAH was defined by an apnea-hypopnea index >20/h. Follow-up was 3 to 21 months. Automated titration during full polysomnography was conducted in the hospital using auto-CPAP devices (Autoset T, RESMED Co, Australia). CPAP alone was done in 37 (50%); CPAP with conservative nasal treatment in 25 (34%) ; CPAP with nasal surgery, endoscopic nose and/or sinus surgery in 10 (14%); and CPAP with uvulopalatopharyngoplasty and endoscopic nose and sinus surgery in 1 patient (1%). CPAP with an oral appliance was done in 1 (1%) to provide lower therapeutic pressure to avoid electroencephalography arousal caused by CPAP. Consequently CPAP with conservative nasal treatment and/or endoscopic nose and sinus surgery were conducted in 36 (49%). It was very important to improve nasal resistance to continue CPAP therapy. No statistically significant differences were seen between compliant and noncompliant patients in severity of OSAH, improvement of daytime somnolence, mask trouble, or nasal resistance. At the latest follow-up, 71 of 74 were still using CPAP. CPAP compliance by Kaplan-Meier evaluation was 96%. Multidisciplinary treatment involving CPAP combined with surgery and oral appliances thus improved the acceptability of CPAP therapy.