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Non-Compliance to CPAP Therapy Linked to Hospital Readmission

A recent study of patients with obstructive sleep apnoea (OSA), implies that non-compliance to continuous positive airway pressure (CPAP) therapy is notably linked with increased 30-day readmission to a hospital facility.

The study shows that non-compliant patients are 3.5 times more probable to be readmitted to the hospital within a span of 30 days. These non-adherent patients are 2 times more likely to be readmitted to the hospital for cardiovascular conditions such as congestive heart failure, myocardial ischemia, and atrial fibrillation which are closely related to untreated obstructive sleep apnoea.

Dr. Behrouz Jafari is the lead study investigator and the director of Veteran Affairs Long Beach Healthcare System in Long Beach, California. He mentioned that prior to this study, no one has considered the role of non-compliance to CPAP therapy in relation to 30-day hospital readmission regardless of illness.  The study aimed to find out the importance of CPAP therapy in decreasing hospital readmissions. Dr. Jafari is also a professor at University of California, teaching pulmonary and critical care medicine.

The study results were published in the Journal of Clinical Sleep Medicine’s February 2018 issue. The subjects of the study are 345 patients diagnosed with sleep apnoea. They were all hospitalized at a Veteran Affairs medical facility starting from January 1, 2007 up to December 31, 2015. Of the 345 patients, 72% were white, and 95% were men. The average age of the 183 CPAP therapy compliant patients is 66 years, while the 162 non-compliant patients had an average age of 62.  In both groups, the apnoea was severe.

Adherence to CPAP therapy is very important

CPAP compliance or adherence of patients should at least be 70%. Based on the definition of Medicare, adherence is undergoing CPAP therapy for at least 4 hours for a consecutive period of at least 30 days. The results of the study were adjusted based on the subjects’ sex, age, race, body mass index, medications, comorbidities and living conditions.

The severity of apneas is defined by the number of times one stops breathing during sleep. According to Dr. Praveen Rudraraju, if person experiences less than 15 apnoeas an hour the condition is mild. If he experiences from 15 up to 30 apnoeas an hour, the condition is moderate, whereas apnoea episodes over 30 in an hour is considered severe.

CPAP therapy is the gold standard in the management and treatment of obstructive sleep apnoea (OSA). Disrupted sleep leaves people fatigued and lethargic during the day. Continuous disrupted sleep over the course of months and even years will ultimate lead to health complications detrimental to the patient, possibly even endangering his life.

Why do some OSA patients refuse to comply with therapy?

There are a number of things to consider for noncompliance of patients. Patients might feel uncomfortable with the way the pressure feels or with wearing the mask. Some may feel claustrophobic and may panic when CPAP machine is turned on.

The important thing is for patients to allot time to get used to mask, pressure and therapy itself. Adjustments are doable for the comfort and ease of patients.  Adherence to CPAP therapy will not only improve a patient’s condition but may well save him numerous trips to the hospital.

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