A retrospective chart review shows hypertension and atrial fibrillation are among the factors associated with poor CPAP/BPAP therapy compliance.

Hypertension, atrial fibrillation (AF), and mask leaks are strongly associated with poor CPAP/bi-level positive airway pressure (BPAP) compliance, according to a retrospective chart review. The study of factors associated with the compliance of CPAP/BPAP use is published in the October 2017 abstract supplement for the journal CHEST and will be presented at CHEST 2017 on Nov 1. Conducted at the Memorial Hospital of Rhode Island, this study also suggests a trend between poor compliance and AF, as well as a higher rate of non-compliance and mean median leakage.

The study defined compliance as CPAP/BPAP usage of 4 hours or more at least 70% of the time. Other factors studied that didn’t yet show significance include gender, body mass index, and age.

“We wanted to look at patients who were not compliant with the PAP therapy and those who were and to seek out ways to improve compliance in those who were struggling with it,” says Faeq Kukhon, MD, internal medicine resident at Warren Alpert Medical School of Brown University/Memorial Hospital of Rhode Island. “So we wanted to find out the reasons behind this problem to address it in the future.”

Though nothing about the results surprised him, Kukhon says the research team could find out more when they continue the study. “Patients who have lower compliance tend to have higher blood pressure and the same applies to AF,” he says. “But an interesting aspect, for example, was that patients who had moderate OSA compared to mild and severe OSA had more difficulty with compliance. So, maybe after we expand the sample size, that statistic, and others, could possibly become more significant.”

Clinically, this study is significant because it shows what factors are related to poor compliance and so will help clinicians address those root problems. “With what we have found so far, we know we can address those factors associated with poor compliance,” says Kukhon. “And when we can do that, we can then try to reverse that trend and possibly improve the overall health of the patient who has poor quality of sleep.”

Kukhon says the main focus of their future studies will remain on the same variables with, ideally, a higher sample size. But they are not ruling out adding other factors in the future. “So far we haven’t added any other variables to the study, though we are starting to think of other things that we could add that we could associate with compliance. For now, however, our main target is expanding the sample size using our original factors because we think that with those factors, we can possibly identify other significant associations with PAP therapy compliance.”

After figuring out the significance of each factor in association with compliance, the next step would be intervention. Kukhon says, “Although it’s way down the line, we have some things that we have already proposed about ways we can improve CPAP compliance in our patients based on these results.”

Dillon Stickle is associate editor of Sleep Review.