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Long-term continuous positive airway pressure (CPAP) outcomes from a sleep service using limited sleep studies and daycase CPAP titration in the management of obstructive sleep apnoea/hypopnoea syndrome

R Carter

A Nicol

R Paton

S W Banham

Department of Respiratory Medicine, Glasgow Royal Infirmary, Glasgow, UK

Background: Detailed polysomnography (PSG) and overnight continuous positive airway pressure (CPAP) titration as the basis for investigation and treatment of obstructive sleep apnoea/hypopnoea syndrome (OSAHS) incurs high costs from inpatient stays and technician attendance, even when split night studies are employed. Responding to rapidly increasing demand, from 1996 the sleep service at Glasgow Royal Infirmary adopted limited sleep studies and daycase CPAP titration as first line management. Here we describe the outcomes of this service between 1996 and 1999. Methods: Data were collected from prospective records made at follow up by sleep technicians and by casenote review. Results: Results were available for 158 subjects (97.5%) of 162 commenced on CPAP during this period. One hundred and forty-eight (91%) were diagnosed by limited sleep studies and 80 (50%) were diagnosed at home. The median follow up was 23 months (interquartile range (IQR), 13-35). Median use of CPAP in those continuing therapy was 5.3 hours/night (IQR, 3.1 to 6.5) and 77% were still using CPAP at three years. Only initial low CPAP compliance (< 2 hours/night) significantly predicted early CPAP cessation. In those still on CPAP in 1999, the mean drop in Epworth Sleepiness Scale score was 4.6 points (95% confidence intervals, 3.2 to 6.0). Conclusion: These data from the CPAP population at Glasgow Royal Infirmary provide information on longterm outcomes using a diagnostic protocol based on limited sleep studies and daycase CPAP titration.

Key Words: compliance • CPAP • limited sleep studies • obstructive sleep apnoea/hypopnoea syndrome

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