Journal Article

Mask side-effects in long-term CPAP-patients impact adherence and sleepiness: the InterfaceVent real-life study

Bourdin, Arnaud, Martinez, Christian, Rotty, Marie-Caroline, Jaffuel, Dany, Suehs, Carey M., Borel, Jean-Christian, Mallet, Jean-Pierre, Rabec, Claudio, Bertelli, Fanny, Molinari, Nicolas

2021

Overview

Background For some patients, Continuous Positive Airway Pressure (CPAP) remains an uncomfortable therapy despite the constant development of technological innovations. To date, no real life study has investigated the relationship between mask related side-effects (MRSEs) and CPAP-non-adherence (defined as < 4 h/day) or residual-excessive-sleepiness (RES, Epworth-Sleepiness-Scale (ESS) score ≥ 11) in the long-term. Methods The InterfaceVent-CPAP study is a prospective real-life cross-sectional study conducted in an apneic adult cohort undergoing at least 3 months of CPAP with unrestricted mask-access (34 different masks). MRSEs were evaluated using visual-analogue-scales, CPAP-data using CPAP-software, sleepiness using ESS. Results 1484 patients were included in the analysis (72.2% male, median age 67 years (IQ 25–75 : 60–74), initial Apnea–Hypopnea-Index (AHI) of 39 (31–56)/h, residual AHI flow was 1.9 (0.9–4) events/h), CPAP-treatment lasted 4.4 (2.0–9.7) years, CPAP-usage was 6.8 (5.5–7.8) h/day, the prevalence of CPAP-non-adherence was 8.6%, and the prevalence of RES was 16.17%. Leak-related side-effects were the most prevalent side-effects (patient-reported leaks concerned 75.4% of responders and had no correlation with CPAP-reported-leaks). Multivariable logistic regression analyses evaluating explanatory-variable (demographic data, device/mask data and MRSEs) effects on variables-of-interest (CPAP-non-adherence and RES), indicated for patient-MRSEs significant associations between: (i) CPAP-non-adherence and dry-mouth (p = 0.004); (ii) RES and patient-reported leaks (p = 0.007), noisy mask (p < 0.001), dry nose (p < 0.001) and harness pain (p = 0.043). Conclusion In long-term CPAP-treated patients, leak-related side-effects remain the most prevalent side-effects, but patient-reported leaks cannot be predicted by CPAP-reported-leaks. Patient-MRSEs can be independently associated with CPAP-non-adherence and RES, thus implying a complementary role for MRSE questionnaires alongside CPAP-device-reported-data for patient monitoring. Trial registration InterfaceVent is registered with ClinicalTrials.gov (NCT03013283).

• Publisher: BioMed Central,BioMed Central Ltd,Nature Publishing Group,BMC
• Subject: Aged / Airway management / Apnea / Care and treatment / Complications and side effects / Continuous positive airway pressure / Continuous Positive Airway Pressure - adverse effects / Continuous Positive Airway Pressure - instrumentation / Continuous Positive Airway Pressure - trends / Cross-Sectional Studies / Demographic variables / Female / Humans / Leaks / Life Sciences / Male / Manufacturers / Mechanical ventilation / Medicine / Medicine & Public Health / Middle Aged / Nose / Patient compliance / Patients / Pneumology/Respiratory System / Population / Principal components analysis / Prospective Studies / Questionnaires / Regression analysis / Reimbursement / Side effects / Sleep / Sleep and wakefulness / Sleep apnea / Sleep apnea syndromes / Sleep Apnea, Obstructive - physiopathology / Sleep Apnea, Obstructive - therapy / Sleep disorders / Sleepiness / Statistics / Technological change / Telemedicine / Variables