Continuous positive airway pressure (CPAP) is an effective treatment against obstructive sleep apnoea, but adherence is often low, and side effects are common. It is unclear from previous research whether side effects are significant causes of nonadherence. No study has examined if side effects vary within subjects over time. The aims were to (1) examine the evolution of CPAP side effects over time, and (2) prospectively assess correlations between early CPAP side effects and treatment adherence.
One hundred eighty-six obstructive sleep apnoea patients from three sleep centres were prospectively enrolled. They completed the Side Effects to CPAP Inventory, where the respondent rates the frequency, magnitude and perceived impact on adherence from 15 side effects. Adherence was measured by treatment dropout and machine usage time.
The most common side effects were dry mouth, increased number of awakenings, blocked up nose, mask pressure and mask leaks. While some side effects were stable over time, others could both resolve and emerge within subjects. Dry mouth, mask leakage and blocked up nose emerged within 1 year in approximately 30 % of patients who had not experienced them after 2 weeks. Increased number of awakenings and dry mouth after 1–2 weeks were significantly associated to treatment dropout during the first year and machine usage time after 6 months.
While some side effects are related to adherence, most are not. Not all side effects are stable over time. This, together with differences in methodology between studies, might explain the conflicting findings in earlier research.
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Lindberg E, Gislason T (2000) Epidemiology of sleep-related obstructive breathing. Sleep Med Rev 4:411–433
Young T, Peppard PE, Gottlieb DJ (2002) Epidemiology of obstructive sleep apnea: a population health perspective. Am J Respir Crit Care Med 165:1217–1239
Marin JM, Carrizo SJ, Vicente E, Augusti AG (2005) Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study. Lancet 365:1046–1053
Smith I, Lasserson TJ (2009) Pressure modification for improving usage of continuous positive airway pressure machines in adults with obstructive sleep apnoea. Cochrane Database of Systematic Reviews Issue 4. Art. No.: CD003531.
Weaver TE, Grunstein RR (2008) Adherence to continuous positive airway pressure therapy: the challenge to effective treatment. Proc Am Thorac Soc 5:173–178
Broström A, Strömberg A, Mårtensson J, Ulander M, Harder L, Svanborg E (2007) Association of Type D personality to perceived side effects and adherence in CPAP-treated patients with OSAS. J Sleep Res 16:439–447
Broström A, Årestedt KF, Strömberg A, Ulander M, Svanborg E (2010) The side-effects to CPAP treatment inventory: the development and initial validation of a new tool for the measurement of side-effects to CPAP treatment. J Sleep Res 19:603–611
Chasens ER, Pack AI, Maislin G, Dinges DF, Weaver TE (2005) Claustrophobia and adherence to CPAP treatment. West J Nurs Res 27:307–321
Pépin JL, Leger P, Veale D, Langevin B, Robert D, Lévy P (1995) Side effects of nasal continuous positive airway pressure in sleep apnea syndrome: study of 193 patients in two French sleep centers. Chest 107:375–381
Meurice JC, Dore P, Paquereau J, Neau JP, Ingrand P, Chavagnat JJ, Patte F (1994) Predictive factors of long-term compliance with nasal continuous positive airway pressure treatment in sleep apnea syndrome. Chest 105:429–433
Iber C, Ancoli-Israel S, Chesson AL Jr, Quan SF (2007) The AASM manual for the scoring of sleep and associated events: rules, terminology and technical specifications. American Academy of Sleep Medicine, Westchester
Epstein LJ, Kristo D, Strollo PJ Jr, Friedman N, Malhotra A, Patil SP, Ramar K, Rogers R, Schwab RJ, Weaver EM, Weinstein MD (2009) Adult obstructive sleep apnea task force of the American Academy of Sleep Medicine. J Clin Sleep Med 5:263–276
Johns MW (1991) A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 14:540–545
Nino-Murcia G, McCann CC, Dliwise DL, Guilleminault C, Dement WC (1989) Compliance and side effects in sleep apnea patients treated with nasal continuous positive airway pressure. West J Med 150:165–169
Lindberg E, Berne C, Elmasry A, Hedner J, Janson C (2006) CPAP treatment of a population-based sample—what are the benefits and the treatment compliance? Sleep Med 7:553–560
Drake CL, Day R, Hudgel D, Stefadu Y, Parks M, Syron ML, Roth T (2003) Sleep during titration predicts continuous positive airway compliance. Sleep 26:308–311
Lewis KE, Seale L, Bartle IE, Watkins AJ, Ebden P (2004) Early predictors of CPAP Use for the treatment of obstructive sleep apnea. Sleep 27:134–138
Olsen S, Smith S, Oei TP (2008) Adherence to continuous positive airway pressure therapy in obstructive sleep apnoea sufferers: a theoretical approach to treatment adherence and intervention. Clin Psychol Rev 28:1355–1371
Engleman HM, Martin SE, Douglas NJ (1994) Compliance with CPAP therapy in patients with the sleep apnoea/hypopnoea syndrome. Thorax 49:263–266
Engleman HM, Asgari-Jirhandeh N, McLeod AL, Ramsay CF, Deary IJ, Douglas NJ (1996) Self-reported Use of CPAP and benefits of CPAP therapy: a patient survey. Chest 109:1470–1476
Janson C, Nöges E, Svedberg-Brandt S, Lindberg E (2000) What characterizes patients who are unable to tolerate continuous positive airway pressure (CPAP) treatment? Resp Med 94:145–149
Denollet J (2000) Type D personality: a potential risk factor refined. J Psychosom Res 49:255–266
Rauscher H, Formanek D, Popp W, Zwick H (1993) Self-reported vs measured compliance with nasal CPAP for obstructive sleep apnea. Chest 103:1675–1680
Krueger PM, Friedman EM (2009) Sleep duration in the United States: a cross-sectional population-based study. Am J Epidemiol 169:1052–1063
Richards D, Bartlett DJ, Wong K, Malouff J, Grunstein RR (2007) Increased adherence to CPAP with a group cognitive behavioral treatment intervention: a randomized trial. Sleep 30:635–640
Olsen SL, Smith SS, Oei T, Douglas J (2012) Motivational interviewing (MINT) improves continuous positive airway pressure (CPAP) acceptance and adherence: a randomised controlled trial. J Cons Clin Psych 80:151–163
Broström A, Fridlund B, Ulander M, Sunnergren O, Svanborg E, Nilsen P (2013) A mixed method evaluation of a group-based educational programme for CPAP use in patients with obstructive sleep apnea. J Eval Clin Pract 19:173–184
MU contributed with study design, statistical analyses and manuscript production. MSJ and AEE contributed with data collection. ES contributed with study design and manuscript production. AB contributed with study design, statistical analyses and manuscript production.
Conflict of interest
Martin Ulander, Malin Svensson Johansson, Amanda Ekegren Ewaldh, Eva Svanborg and Anders Broström have no conflicts of interest to disclose.
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Ulander, M., Johansson, M.S., Ewaldh, A.E. et al. Side effects to continuous positive airway pressure treatment for obstructive sleep apnoea: changes over time and association to adherence. Sleep Breath 18, 799–807 (2014). https://doi.org/10.1007/s11325-014-0945-5
- Obstructive sleep apnoea/adverse effects
- Continuous positive airway pressure
- Side Effects to CPAP Inventory