Continuous positive airway pressure (CPAP) has been the “gold standard” of treatment for OSA since the 1970s. As I mentioned in the last post, it is a mask that the patient wears while sleeping which pumps pressurized air to hold open the throat and mouth so that air can pass freely.
CPAP has a lot of advantages. First, it is not invasive and essentially has no risks. Second, it DOES cure sleep apnea but with the very important caveat that the patient MUST WEAR IT for it to work.
And there lies the million dollar problem. And that problem is that CPAP is a difficult treatment to follow consistently all night every night.
In my practice as a resident and post residency, I would estimate that up to 50% of patients who are prescribed CPAP for sleep apnea either refuse to use it or stop within a few weeks. Of those who continue with it, many drop out over the next few months to years.
Unfortunately, for CPAP to be a true cure for OSA, patients need to keep wearing it for the rest of their lives usually (barring major weight loss or successful sleep surgery, neither of which is a given in most patients).
What does the research say? There have been numerous studies in the medical literature that study patient compliance to CPAP therapy. In the first year, research studies have shown a wide range of 4% to 74% of patients who quit using their CPAP. Many of these studies have been done internationally (Canada and Europe) in cultures which may place more value on conformity than places like Texas, with our fierce independent streak.
For patients who do use their CPAP, how many use it for over 4 hours a night? (which is the minimum amount to be at all effective) A series of studies from Europe in the 1990s shows a wide range from 29-83% of patients who wore their CPAP nightly but used it for less than 4 hours a night on average.
So, the answer is that no one really knows how faithfully patients will wear their CPAP. It’s certainly impossible to predict for any individual patient.
Long term programs to monitor CPAP use and provide education and follow-up with patients have been proven to help, but these sorts of programs are difficult to implement in the US, and have been more common in European countries and other places with socialized health care.
So, the moral of the story is that CPAP has flaws but it has been the best weapon we have at fighting OSA. As we will learn in the next post, there are many potential surgeries that can improve or potentially cure obstructive sleep apnea, but many of them do not work very well and can also have a very painful recovery after surgery.
For those of us who treat sleep apnea, we have been searching for the “Holy Grail” of sleep apnea surgery- namely a procedure that is minimally invasive and office-based that can effectively cure or at least improve sleep apnea. In the upcoming 6th and final post of the OSA series, I will talk about some promising new office-based procedures that carry much less risk and post-procedure pain but can have a dramatic effect on sleep apnea.
The next post will discuss surgery for sleep apnea.