Effect of APAP and heated humidification with a heated breathing tube on adherence, quality of life, and nasopharyngeal complaints

Abstract

Purpose

Positive airway pressure (PAP) therapy adherence can be affected by rhinitis sicca and xerostomia complaints. Additional heated humidification (HH) is the appropriate method when such complaints arise. The aim of this study was to determine if HH with a supplementary heated breathing tube can increase adherence, reduce subjective nasopharyngeal complaints (NPC), and improve sleepiness (ESS: Epworth Sleepiness Scale) and quality of life (FOSQ: Functional Outcome of Sleep Questionnaire).

Methods

We subdivided 72 obstructive sleep apnea (OSA) patients into two groups before therapy initiation. The NPC risk group consists of subjects with NPC and the low-risk group without. The risk group was identified by a score of >9 in a 5-item 25-point NPC questionnaire and pathological ESS. All patients were eligible for automatic CPAP devices (APAP), which were randomly configured with or without HH during 6 weeks.

Results

The adherence differences with and without HH were not significant in the NPC risk group (330 ± 103 vs. 281 ± 118 min/night) and in the low-risk group (330 ± 116 vs. 321 ± 89). NPC and ESS scores in the risk group were both significantly reduced with HH. Daily function (FOSQ) in the risk group was significantly improved with HH (90.0 ± 11.9 vs. 82.0 ± 12.0 (p < 0.05)).

Conclusion

HH showed a tendency to improve APAP adherence. The adherence in both groups was quite high, and for that reason, it is difficult to show a statistically significant effect. A differentiation into NPC risk groups before starting PAP treatment is useful. HH reduces side effects and sleepiness and improves quality of life in an NPC risk group.

This is a preview of subscription content, log in to check access.

Fig. 1

References

  1. 1.

    Hoffstein V, Viner S, Mateika S et al (1992) Treatment of obstructive sleep apnea with nasal continuous positive airway pressure patient compliance, perception of benefits, and side effects. Am Rev Respir Dis 145:841–845

    CAS  Article  PubMed  Google Scholar 

  2. 2.

    Kribbs NB, Pack AI, Kline LR et al (1993) Objective measurement of patterns of nasal CPAP use by subjects with obstructive sleep apnea. Am Rev Respir Dis 147:887–895

    CAS  Article  PubMed  Google Scholar 

  3. 3.

    Engleman HM, Martin SE, Douglas NJ (1994) Compliance with CPAP therapy in subjects with the sleep apnea/hypopnea syndrome. Thorax 49:263–266

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  4. 4.

    Pepin JL, Leger P, Veale D et al (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

    CAS  Article  PubMed  Google Scholar 

  5. 5.

    Randerath WJ, Meier J, Genger H et al (2002) Efficiency of cold passover and heated humidification under continuous positive airway pressure. Eur Respir J 20:183–6

    CAS  Article  PubMed  Google Scholar 

  6. 6.

    Fischer Y, Keck T, Leiacker R et al (2008) Effects of nasal mask leak and heated humidification on nasal mucosa in the therapy with nasal continuous positive airway pressure (nCPAP). Sleep Breath 12:353–7

    Article  PubMed  Google Scholar 

  7. 7.

    Martins De Araújo MT, Vieira SB, Vasquez EC et al (2000) Heated humidification or face mask to prevent upper airway dryness during continuous positive airway pressure therapy. Chest 117:142–7

    Article  PubMed  Google Scholar 

  8. 8.

    Richards GN, Cistulli PA, Ungar RG et al (1996) Mouth leak with nasal continuous positive airway pressure increases nasal airway resistance. Am J Respir Crit Care Med 154:182–6

    CAS  Article  PubMed  Google Scholar 

  9. 9.

    Ryan S, Doherty LS, Nolan GM et al (2009) Effects of heated humidification and topical steroids on compliance, nasal symptoms, and quality of life in patients with obstructive sleep apnea syndrome using nasal continuous positive airway pressure. J Clin Sleep Med 5:422–7

    PubMed  PubMed Central  Google Scholar 

  10. 10.

    Massie CA, Hart RW, Peralez K et al (1999) Effects of humidification on nasal symptoms and compliance in sleep apnea patients using continuous positive airway pressure. Chest 116:403–8

    CAS  Article  PubMed  Google Scholar 

  11. 11.

    Budhiraja R, Parthasarathy S, Drake CL et al (2007) Early CPAP use identifies subsequent adherence to CPAP therapy. Sleep 30:320–324

    PubMed  Google Scholar 

  12. 12.

    Duong M, Jayaram L, Camfferman D et al (2005) Use of heated humidification during nasal CPAP titration in obstructive sleep apnoea syndrome. Eur Respir J 26:679–85

    CAS  Article  PubMed  Google Scholar 

  13. 13.

    Wiest GH, Harsch IA, Fuchs FS et al (2002) Initiation of CPAP therapy for OSA: does prophylactic humidification during CPAP pressure titration improve initial patient acceptance and comfort? Respiration 69:406–12

    CAS  Article  PubMed  Google Scholar 

  14. 14.

    Yu CC, Liu CM, Liu YC et al (2013) The effects of heated humidifier in continuous positive airway pressure titration. Sleep Breath 17:133–8

    Article  PubMed  PubMed Central  Google Scholar 

  15. 15.

    Rakotonanahary D, Pelletier-Fleury N, Gagnadoux F et al (2001) Predictive factors for the need for additional humidification during nasal continuous positive airway pressure therapy. Chest 119:460–5

    CAS  Article  PubMed  Google Scholar 

  16. 16.

    Nilius G, Franke KJ, Domanski U et al (2007) Upper airway complaints of patients with obstructive sleep apnea—effect of CPAP. Pneumologie 61:15–9

    CAS  Article  PubMed  Google Scholar 

  17. 17.

    Johns MW (1993) Daytime sleepiness, snoring, and obstructive sleep apnea. The Epworth Sleepiness Scale. Chest 103:30–6

    CAS  Article  PubMed  Google Scholar 

  18. 18.

    Weaver TE, Laizner AM, Evans LK et al (1997) Instrument to measure functional status outcomes for disorders of excessive sleepiness. Sleep 20:835–43

    CAS  PubMed  Google Scholar 

  19. 19.

    Iber C. for the American Academy of Sleep Medicine (2007) The AASM manual for the scoring of sleep and associated events: rules, terminology and technical specifications. Westchester, IL: American Academy of Sleep Medicine

  20. 20.

    Ruhle KH, Franke KJ, Domanski U et al (2011) Quality of life, compliance, sleep and nasopharyngeal side effects during CPAP therapy with and without controlled heated humidification. Sleep Breath 15:479–85

    Article  PubMed  Google Scholar 

  21. 21.

    Neill AM, Wai HS, Bannan SP et al (2003) Humidified nasal continuous positive airway pressure in obstructive sleep apnoea. Eur Respir J 22:258–62

    CAS  Article  PubMed  Google Scholar 

  22. 22.

    Mador MJ, Krauza M, Pervez A et al (2005) Effect of heated humidification on compliance and quality of life in patients with sleep apnea using nasal continuous positive airway pressure. Chest 128:2151–8

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This research was supported by Fisher & Paykel Healthcare.

Conflicts of interest

K.H. Ruhle and G. Nilius have received research funding from Fisher & Paykel Healthcare, Heinen und Löwenstein, ResMed and Weinmann; this has gone into department funds. Karl-Josef Franke, Ulrike Domanski, and Maik Schroeder have no financial or other potential conflicts of interest associated with this investigation.

Registration

The study was approved by the ethic committee of the university of Witten/Herdecke. The study is registered in the Clinical Trial Register under the ClinicalTrials.gov Identifier NCT01517750.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Georg Nilius.

Additional information

Clinical trial registration

The study is registered under the ClinicalTrials.gov Identifier NCT01517750

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Nilius, G., Franke, K.J., Domanski, U. et al. Effect of APAP and heated humidification with a heated breathing tube on adherence, quality of life, and nasopharyngeal complaints. Sleep Breath 20, 43–49 (2016). https://doi.org/10.1007/s11325-015-1182-2

Download citation

Keywords

  • Humidification
  • Quality of life
  • OSA
  • APAP
  • Adherence