[Follow-up examination and probatory CPAP therapy of obstructive sleep apnoea increase the long-term compliance]

Since the implementation of CPAP therapy in the treatment of obstructive sleep apnoea in the 1980 s researchers have been looking for predictors and possibilities to improve long-term compliance. In a prospective randomised trial we examined the influence of a follow-up examination two weeks after the start of probatory CPAP therapy compared to immediate prescription of the CPAP device.

249 new patients with a newly diagnosed obstructive sleep apnoea (OSA) started with a CPAP therapy. These patients were prospectively randomised depending on the dates of admission (even/uneven). The CPAP device for the first group was immediately prescribed. Patients of the second group were seen in our sleep laboratory ambulance after a probatory usage of the CPAP therapy over a period of fourteen days. After 433 +/- 138 days we measured the compliance by reading off the operating hours counter. In order to collect these data all patients received written simple instructions how to read off the operating hours counter. They sent back the results via a prepaid return envelope. In addition, we obtained the information as to whether a hot water bath humidifier was used.

171 of the initially 249 patients sent back the evaluation form. The randomisation of the groups was successful concerning: age, sex as well as the apnoea-hypopnoea index before and under CPAP therapy. 226 patients were treated with the fix-CPAP mode (mean pressure 8.1 +/- 1.8 cm H(2)O), 23 patients received auto CPAP therapy. The patients with a probatory CPAP therapy and follow-up examination showed a significantly (p = 0.01) better compliance of nocturnal CPAP use with 4.5 +/- 1.8 h/night versus those who had their CPAP device immediately prescribed with a use of 3.8 +/- 2.1 h/night. The percentage of patients with a use of CPAP more than 4 h/night was significantly higher in the group with probatory therapy (66.3 % vs. 45.6 %; p = 0.008). Patients with probatory CPAP therapy made more use of humidifiers than the immediate prescription group; however, the use of a humidifier did not have any significant influence on the long-term compliance (p = 0.58).

The combination of probatory CPAP therapy and follow-up examination increases the long-term compliance significantly in the treatment of obstructive sleep apnoea.