Improvement of sleep parameters by titration polysomnography could predict adherence to positive airway pressure therapy in obstructive sleep apnea
- S-Med
- Nov 6
- 2 min read
his study obtained sleep parameters and self-reported sleep status during both dPSG and tPSG. CPAP adherence in patients with OSA could be predicted by examining the changes in various indices with CPAP use. PSG evaluations demonstrated that CPAP adherence can be expected in patients who demonstrated improvements in AHI, sleep architecture, such as stage N1% and N3%, TST, sleep efficiency, and sleep latency with CPAP. These findings were correlated with self-reported sleep improvement. In addition, more significant improvements in sleep architecture, sleep efficacy, and self-reported sleep status with CPAP could result in better adherence. These findings suggest the importance of evaluating both self-reported and objective sleep indices during tPSG for predicting CPAP adherence.
Several previous reports have investigated the relationship between CPAP adherence and sleep parameters during tPSG. Somiah et a reported that 93 patients with short-term (1 week) good adherence displayed lower stage N2% and higher stage R% on tPSG; Drake et al demonstrated that an improvement in sleep efficiency on tPSG was correlated with CPAP adherence (71 patients, 47 days). In the present study, we demonstrated that short to midterm CPAP adherence was correlated with an improvement in sleep parameters during the first night of CPAP use in a larger population. Although there were some different findings in our study compared to other studies, such as the relatively high baseline stage N1%, they may be due to different patients’ backgrounds such as age, sex, and severity of disease. Furthermore, in our study, patients with better adherence to CPAP had higher stage N1%, lower stage N3%, longer sleep latency, and lower sleep efficacy in the dPSG. Although the full impact of these parameters on CPAP adherence is unclear, it is reasonable to assume that the degree of improvement patients using CPAP experience in these parameters contributes to enhanced CPAP adherence. In addition, a randomized control study revealed that CPAP resulted in a lower arousal index, less stage N1, and higher stage N3 but no increase in stage R; these parameters were correlated with decrease in sleepiness. These findings suggested the importance of a change in sleep parameters and the initial experience with CPAP. This necessitates an active approach to enhance CPAP adherence in patients who may display poor adherence from tPSG data. For example, researchers should make active efforts to improve sleep parameters during the tPSG study. In lieu of considering conducting another tPSG study, we recommend patients visit our clinic earlier than the usual 1-month visit to investigate the cause of poor PSG results. We recommend patients visit our clinic earlier than the usual 1-month visit to investigate the cause of poor PSG results, in addition to considering conducting another tPSG study.
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