Summary
Problems and side effects resulting from CPAP treatment in patients with OSAS can often be solved during therapy initiation. However, some symptoms develop several weeks or even months after treatment has started. Well-known determinants of noncompliance are the patient being comparatively only slightly overweight and lack of daytime sleepiness as well as high treatment pressure and oronasal problems. These criteria, however, correlate poorly with actual long-term compliance rates. Therefore follow-up examinations are necessary to detect non-compliant patients. Several studies have repeatedly shown high effectiveness of follow-up procedures. However, methods without sufficient evidence for wide-spread use are also being used.
High compliance is important because the usage of more than 6 hours per night can considerably improve life expectancy in OSAS patients. Measures to improve compliance of proven effectiveness are repeated sessions of education, psychosocial interventions, use of alternative treatments, prescription of a heated humidifier, changing to an alternate mask, detection of mouth leakage and treatment of persisting or reappearing daytime sleepiness.
Thus, by periodic controls an amelioration of usage time and a better cost-effectiveness ratio can be achieved with relative low expenditure.
Zusammenfassung
Zwar können viele durch die Therapie entstehenden Probleme während der Ersteinstellung von Patienten mit obstruktivem Schlafapnoesyndrom mit CPAP beseitigt werden, dennoch treten häufig erst nach einigen Wochen oder Monaten Nebenwirkungen auf, die die Therapieakzeptanz erheblich reduzieren. Einige bekannte Vorhersagekriterien einer schlechten Compliance stellen relativ geringes Übergewicht, fehlende Tagesschläfrigkeit, hohe Beatmungsdrucke sowie Nasen-Rachen-Probleme dar. Diese Vorhersagekriterien korrelieren aber zu wenig mit der tatsächlichen Anwendungszeit, sodass eine genauere Aussage und Behebung der Probleme erst durch Nachkontrollen möglich ist. Die Effekte der Nachsorgemaßnahmen sind oftmals durch Untersuchungen mit hoher Evidenz nachgewiesen worden. Allerdings werden auch Methoden eingesetzt, deren Evidenzgrad für eine breite Anwendung noch nicht ausreichend ist. Eine hohe Compliance besitzt große Bedeutung: Wenn eine normale Anwendungsdauer von über sechs Stunden erreicht wird, kann die Lebenserwartung der OSAS-Patienten erheblich verbessert werden. Maßnahmen zur Verbesserung der Compliance beinhalten eine mehrfache Schulung, psychosoziale Interventionen, Umstellung auf andere Therapieverfahren, Behandlung der Trockenheit der Mund- und Rachen-Schleimhäute mit Warmluftbefeuchtung, Anpassung geeigneter Masken, Erkennung von Mundatmung und Behandlung bleibender oder erneut auftretender Schläfrigkeit. Durch regelmäßige Kontrollen kann demnach mit relativ geringem Aufwand eine wesentliche Verbesserung der Anwendungszeit und damit auch eine bessere Kosten-Nutzen-Relation erzielt werden.
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Rühle, KH., Orth, M., Galetke, W. et al. Die Bedeutung von Kontrolluntersuchungen bei Patienten mit schlafbezogenen Atmungs-Störungen. Somnologie 12, 252–256 (2008). https://doi.org/10.1007/s11818-008-0358-4
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DOI: https://doi.org/10.1007/s11818-008-0358-4