[Long-term compliance of cpap-therapy--update, predictors and interventions]

Insomnia symptoms influence CPAP compliance

PURPOSE

The aim of this study is to determine parameters which influence 6-month compliance of continuous positive airway pressure therapy (CPAP) in patients with obstructive sleep apnea syndrome (OSAS).

METHODS

This prospective study investigated 73 patients (24 females) with OSAS and medical indication for CPAP therapy: age 55.1 ± 11.5 years, body mass index (BMI) 30.8 ± 5.0 kg/m2, Apnea-Hypopnea Index (AHI) 39.2 ± 26.7/h, Oxygen Desaturation Index (ODI) 33.2 ± 25.4/h, minimum O(2) saturation 78.9 ± 7.6%. The influence of baseline parameters (demographic and polysomnographic data, sleeping medication intakes, BMI, psychometrics [Epworth Sleepiness Scale, Regensburg Insomnia Scale, Vigilance test and Beck Depression Inventory]) on 6-month compliance was evaluated with a correlation and a linear regression analysis.

RESULTS

The baseline value of the Regensburg Insomnia Scale (RIS) predicts 6-month CPAP compliance (r = -0.376, R (2) = 0.14, p < 0.001), although no other baseline parameter correlates. Patients with a compliance of <4 h/night show higher RIS scores, i.e., more insomnia symptoms (17.6 ± 8.8) compared to those with ≥4 h/night (12.6 ± 6.9; p < 0.05).

CONCLUSIONS

Insomnia symptoms prior to the beginning of CPAP treatment show a negative influence on CPAP compliance. Further studies should clarify, if a treatment of insomnia symptoms leads to a benefit in compliance.

Atomoxetine improves sleepiness and global severity of illness but not the respiratory disturbance index in mild to moderate obstructive sleep apnea with sleepiness

BACKGROUND AND PURPOSE

Norepinephrine reuptake inhibitors such as protriptyline have been shown to improve sleepiness in sleep apnea, with or without improvement in the respiratory disturbance index (RDI). This study was performed to evaluate whether the selective norepinephrine reuptake inhibitor atomoxetine improves sleepiness, the clinical global impression (CGI) of severity of illness, and the RDI in patients with mild to moderate obstructive sleep apnea with excessive sleepiness.

METHODS

Patients aged 18-60 years with RDI (including apneas, hypopneas with desaturations and hypopneas with arousals) >5/h sleep, apnea-hypopnea index (AHI; including apneas, hypopneas with 4% desaturations, but not apneas with arousals) <15/h sleep, and excessive sleepiness (Epworth Sleepiness Scale [ESS]>or=10) received open-label treatment with atomoxetine 40-80 mg HS for 4 weeks, with repeat polysomnography at the end of treatment. Of 20 patients screened, 17 started treatment and 15 completed treatment.

RESULTS

ESS improved from 15.3 to 10.5 and CGI improved from 4.3 to 3.1 (both significant at p<0.01), but there was no significant change in RDI. ESS and CGI improved in a linear fashion across the weeks of treatment. Sleep efficiency and % stage rapid eye movement (REM) sleep were decreased, and % stage 1, awakenings and wake after sleep onset were increased.

CONCLUSIONS

Atomoxetine improved sleepiness and the CGI in patients with mild to moderate obstructive sleep apnea with sleepiness. However, it did not improve the RDI.