The importance of clinical monitoring for compliance with Continuous Positive Airway Pressure

Various Factors Affecting Short-Term Compliance Rates of CPAP in OSA Patients: in the Age of Insurance Coverage in Korea

Background and Objectives: Although many studies have explored the factors affecting compliance with continuous positive airway pressure (CPAP) in patients with obstructive sleep apnea (OSA), the findings remain controversial. This study aimed to analyze CPAP compliance after insurance coverage began in Korea and to investigate what factors influenced CPAP compliance.Materials and Method: The subjects were 1,037 patients who were prescribed a CPAP after polysomnography at the Seoul Sleep Clinic; data were reviewed retrospectively. We classified those that used a CPAP for more than 4 hours per day for 70% or more days per month as into the good compliance group. We compared the ratio of good compliance by gender, position dependence, rapid eye movement (REM) dependence, telemonitoring of CPAP, pressure modification, and OSA severity.Results: There were no statistically significant differences in ratio of good compliance group according to gender, position dependence, REM dependence, or disease severity. When using a fixed CPAP (92.2%) rather than an auto PAP (88.4%), the ratio of patients in the good compliance group was significantly higher. Non-positioner and fixed CPAP users showed significantly longer average usage time.Conclusion: In a 3-month short-term follow-up study of CPAP compliance, the telemonitoring group and those using a fixed CPAP showed a higher ratio of good compliance. Average CPAP usage time was longer when using a fixed CPAP and in non-positioners. As age increased, CPAP usage time was longer, and the average compliance rate tended to increase.

Assistive technology to enable sleep function in patients with acquired brain injury: Issues and opportunities

Introduction

Sleep disorders in patients with acquired brain injury are highly burdensome and associated with disability. An assistive technology framework emphasises the need to develop and apply a broad range of devices, strategies, and practices to ameliorate disabilities. We aimed to summarise scientific evidence regarding the utility of assistive technology in managing sleep disorders in patients with various causes of acquired brain injury.

Method

We retrieved articles before January 2016, through database searches of Medline, Embase, PsycINFO, CINAHL, and various bibliographies. The person–environment–occupation framework was used to analyse complex data pertaining to technology application and utility.

Results

We found 21 studies that described seven assistive technologies (continuous positive airway pressure, adaptive servo ventilator, nasotracheal suction mechanical ventilation, positioning devices, cognitive behavioural therapy, light therapy, and acupuncture) utilised in patients with acquired brain injury to manage sleep disorders.

Conclusion

Assistive technologies demonstrated effectiveness in alleviating and/or managing sleep disorders after acquired brain injury. Adherence to using the technology is limited by the level of injury-induced cognitive and physical impairment, technological regime, and environmental support. Development of user-friendly sleep-assistive technologies that take into consideration functional limitations and practice guidelines on structural communication between the occupational therapist, patient, and caregiver may facilitate patients’ self-determination in managing sleep disorders.