The relati̇on between adherence to posi̇ti̇ve ai̇rway pressure treatment and pulmonary functi̇ons i̇n obstructi̇ve sleep apnea syndrome

Purpose: OSAS (Obstructive sleep apnoea syndrome) is a syndrome characterized by recurrent episodes of complete (apnoea) or partial (hypopnoea) upper respiratory airway obstruction and often accompanied by a decrease in blood oxygen saturation. Polysomnography (PSG) is the gold standard method utilized in the diagnosis of OSAS. Successful management of sleep apnoea not only improves sleep quality and quality of life but also helps to prevent most of the serious complications associated with the syndrome, in which positive airway pressure (PAP) treatment is the main modality of management. However, issues regarding compliance and adherence to the device are often experienced by patients and clinicians alike. In this study, we aim to investigate the association between patients' compliance with PAP treatment and the results of their pulmonary function tests (PFT). Materials and Methods: : Patients included in this study were diagnosed with OSAS in the Sleep Study Lab at the Department of Pulmonology in Duzce University, who was then admitted to the Pulmonology ward for PAP titration, successfully titrated, issued with a PAP device report and provided with a device, all of whom had given their consent to the study. Their demographic features and complaints regarding the device and its mask which affected their adherence to the treatment, and their depression and anxiety scale scores were evaluated along with their PFT parameters. Conclusion: 63% of 98 individuals (n=62) were males and their average age was 52 ± 9,6 (29-72). 67% of patients were found to be compliant with devices they were provided with. A statistically significant difference (p<0,05) was observed in different grades of OSAS in terms of patient compliance. Patients with severe OSAS were found to be more compliant. Beck Depression Scale (BDS) and Beck Anxiety Scale (BAS) scores of device-compliant patients were observed to be lower than the non-compliant, which was also statistically significant (p<0,001 and p=0,044, respectfully). There were no significant differences in terms of separate PFT parameters (p>0,05). Rates of nasal cannula use, tolerance of CPAP, ability to fall asleep quickly, no abdominal discomfort or facial lacerations due to the mask, no leakage of oxygen, benefit from the device, reduction in daytime sleepiness and the thought that adequate and appropriate treatment had been administered in patients who complied with the device were significantly higher than those who were not compliant (p<0,05). Claustrophobia, discomfort concerning pressure were also significantly lower in complying patients than non-complying patients (p<0,05). A forward Wald multiple logistic regression model was established using variables which were found to affect the patients' compliance rates, which showed that an increase BDS scale score increased the non-compliance odds ratio by 1,08, the complaint of air leakage by 6,82, pressure discomfort by 5,21, and absence of improvement in daytime sleepiness by 5,87. Result: Whereas an association between PFT parameters and compliance to PAP treatment wasn't established, statistically significant factors that affected device compliance were detected. In patients with OSAS, high-risk groups in terms of compliance should be identified before starting PAP treatment, and educational support should be provided. Our view is that close followups of patients and solution of their complaints regarding treatment could improve their compliance with PAP treatment.