Skip to main content

Advertisement

Advertisement

Advertisement

Advertisement

ADVERTISEMENT

Commentary

Identifying and Addressing Barriers to CPAP Therapy in Patients With Obstructive Sleep Apnea

By: Yvette C. Terrie, BS Pharm, RPh, Consultant Pharmacist

In a previous post, the detrimental health effects of undiagnosed obstructive sleep apnea (OSA) were discussed. In this post, the issues associated with non-compliance to therapy for OSA will be addressed. This is an ongoing issue for many in this patient population and the issues contributing to non-compliance to CPAP therapy should be identified and addressed early on to increase patient compliance, thus possibly improving overall clinical outcomes.

Continuous positive air pressure (CPAP) is considered as the gold standard of therapy for sleep apnea. When used as prescribed, CPAP reduces daytime sleepiness, normalizes sleep architecture, and improves numerous OSA-specific health outcomes. 1 Despite the soaring number of individuals diagnosed with sleep apnea and the host of detrimental health effects associated with undiagnosed and untreated sleep apnea, many individuals with sleep apnea are non-compliant to the prescribed CPAP therapy. In fact, various studies indicate that nonadherence rates generally range between 30% to 80%.1,2 Additionally, an estimated 50%  of patients who are prescribed CPAP therapy discontinue it within the first year.2  Common complications that contribute to patient nonadherence include difficulty falling asleep with mask, improper fit of mask, nasal dryness and congestion, feelings of claustrophobia, facial skin abrasions, air leaks, and conjunctivitis.1 Non-adherence with CPAP therapy can result in daytime sleepiness and negatively impact daily functioning as well as increase blood pressure. Research has also indicated that many patients who start on a path to non-adherence commonly remain non-adherent and ultimately abandon the machine altogether, with consequent return of symptoms and OSA-specific adverse consequences.1 According to the American Academy of Sleep Medicine (AASM), several studies have revealed that the use of CPAP therapy is associated with various health benefits such as lowering of blood pressure, decreases in cardiovascular events and coronary artery disease in adults with OSA, and improvement in lipid profile.3  Additionally, the routine use of CPAP therapy has been associated with reduction of daytime sleepiness, improvement in insulin sensitivity, increases in daytime alertness and daytime concentration.3

The multifaceted roles of pharmacists in clinical practice continue to evolve and as one of the most easily accessible health care providers, pharmacists are in a pivotal position to augment awareness about the significance of treating OSA. In a recent publication, a review was conducted to identify the current published evidence of and the impact of pharmacists who provide OSA screening services in a community pharmacy setting. They found that a total of 1,701 pharmacies encompassing 9,177 patients were screened in the clinical studies. Pharmacists were able to identify between 21.4 and 67% of patients that were at risk for developing OSA or required a referral to a general practitioner or sleep disorder specialist for further diagnostic testing.4

As frontline health care providers, pharmacists can be instrumental in increasing awareness about OSA, its harmful effects on health and quality of life if undiagnosed and untreated. They can also act as patient identifiers, patient educators and patient advocates by identifying patients that may be at risk for OSA, those who are noncompliant and educate those patients about the benefits of CPAP therapy. They can also encourage patients to discuss their concerns about CPAP therapy with their sleep specialists as well as explore the various noninvasive CPAP masks that can replace full face masks such as nasal pillows on the market and the oral appliances used as an alternative for CPAP therapy. The AASM guideline suggests that oral appliances may be selected over CPAP in mild-to-moderate disease based on patient preference or intolerance to CPAP.

In their daily practice, pharmacists are likely to encounter patients exhibiting signs of OSA or those at risk for OSA and they should encourage those patients to seek further evaluation from their primary health care provider. Moreover, pharmacists can also identify pharmacological agents that may exacerbate OSA and make clinical recommendations accordingly as warranted. They can also recommend lifestyle changes such as weight loss, avoidance of tobacco use and alcohol and avoiding supine sleeping positions based on patient need. It is imperative for all health care professionals to seize every opportunity to increase awareness about OSA, assist patients in understanding the grave health consequences associated with untreated OSA, the health benefits associated with CPAP therapy and provide patients with the essential information needed to increase patient compliance to effectively manage OSA.  Treating OSA and remaining compliant to therapy will not only enable patients to finally get a good night sleep every night, but more importantly, compliance to CPAP therapy may actually reduce or prevent critical health issues and even premature death. It is imperative that health care providers routinely monitor patients and identify and address patient issues regarding CPAP therapy early on in therapy to increase the likelihood that patients will maintain compliance.

Yvette C. Terrie, Consultant Pharmacist, Medical Writer and creator of A Pharmacist’s Perspective (https://apharmacistsperspective.blogspot.com/).

References:

  1. Rotenberg BW, Murariu D, Pang KP. Trends in CPAP adherence over twenty years of data collection: a flattened curve. J Otolaryngol Head Neck Surg. 2016;45(1):43. Published 2016 Aug 19. doi:10.1186/s40463-016-0156-0.
  2. Park, Pona MD; Kim, Jinil MD; Song, Yoon Jae MD; Lim, Jae Hyun MD; Cho, Sung Woo MD; Won, Tae-Bin MD, PhD  et al. Influencing factors on CPAP adherence and anatomic characteristics of upper airway in OSA subjects, Medicine: December 2017 - Volume 96 - Issue 51 - p e8818 doi: 10.1097/MD.0000000000008818.
  3. CPAP - Benefits. Sleep Education. American Academy of Sleep Medicine website https://sleepeducation.org/essentials-in-sleep/cpap/benefits. Accessed June 17, 2020.
  4. Cawley, M.J., Warning, W.J. A systematic review of pharmacists performing obstructive sleep apnea screening services. Int J Clin Pharm 38, 752–760 (2016). https://doi.org/10.1007/s11096-016-0319-0.

Advertisement

Advertisement