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Vol. 31. Issue 2.
Pages 56-61 (February 1995)
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Vol. 31. Issue 2.
Pages 56-61 (February 1995)
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Cumplimiento del tratamiento con presión positiva continua nasal (CPAP) en el síndrome de las apneas-hipopneas durante el sueño
Compliance with nasal continuous positive airway pressure for apnea-hypopnea during sleep
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A. Alarcón, C. León, R. Rodríguez-Roisin, J.M. Montserrat1
Serveis de Pneumologia. Hospital Clínic i Provincial. Barcelona
A. Maimó*, F. Barbé*, A.G.N. Agustí*, A. Granados**
* Serveis de Pneumologia. Hospital Universitario Son Dureta, Palma de Mallorca. Barcelona
** Serveis de Pneumologia. Agència d’Evaluació de Tecnologia Mèdica (Servei Català de la Salut). Barcelona
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Desde su introducción en 1981 por Sullivan, la presión continua nasal en la vía aérea superior (CPAP) durante la noche es el tratamiento estándar para el síndrome de la apnea-hipopnea durante el sueño (SAHS). Sin embargo, este tratamiento se efectúa a expensas de un coste económico elevado, algunos pacientes no la toleran y su eficacia está en relación al grado de cumplimiento del tratamiento. El propósito del presente estudio ha sido analizar el grado de cumplimiento del tratamiento con CPAP durante los primeros 3 meses en un grupo de 142 pacientes consecutivos afectados de un SAHS de moderada-severa intensidad (índice de apneahipopnea: 48,9±20) que precisaban CPAP para su tratamiento. El diagnóstico y la medición del nivel de presión de CPAP (9,6±2,5cm H2O) necesarios se efectuó mediante polisomnografía. De estos, 18 pacientes (13%) no volvieron a control. En los 124 restantes (54±11 años), el cumplimiento del tratamiento se valoró a través de un diario del sueño que el sujeto cumplimentaba y en donde anotaba las horas de utilización nocturna de la CPAP, y se cotejaban los datos obtenidos con los del contador horario que llevaba incorporado el generador de CPAP. A todos los sujetos se les interrogaba acerca del grado de somnolencia previo al tratamiento, mediante un cuestionario estandarizado. Aunque la mayoría de los pacientes, según su diario del sueño, manifestaban una utilización regular de la CPAP, sólo aproximadamente un 60% de los casos la utilizaban un promedio diario superior a 4,5 horas. Los “cumplidores” no podían diferenciarse de los “no cumplidores” ni por el grado de somnolencia inicial ni por el índice de apnea/hipopnea hora ni por el nivel de presión de CPAP requerida.

Conclusiones

a) la opinión del enfermo en cuanto al grado de cumplimiento del tratamiento con CPAP no siempre refleja su grado real de utilización; b) durante los primeros

Palabras clave:
Cumplimiento
Síndrome de apnea del sueño
Presión continua basal en la vía aérea superior

Ever since Sullivan introduced nighttime nasal continuous pressure on the upper airway (CPAP) in 1981 it has been the standard treatment for sleep-hypopnea syndrome (SAHS). However, CPAP is carried out at great expense and is not tolerated by all patients. Moreover, its efficacy is dependent on the degree of compliance. In this study we set out to analyze the degree of compliance with CPAP over the first 3 months of treatment in a group of 142 consecutive patients with moderate to severe SAHS (apnea-hypopnea index: 48.9±20). Diagnosis and measurement of the level of CPAP needed (9.6±2.5cm H2O) were based on polysomnography. Eighteen (13%) patients did not return for follow-up evaluation. In the remaining 124 patients (age 54±11 years) compliance with treatment was evaluated by way of a sleep diary in which the patient recorded the hours CPAP was used at night; this record was compared with readings from the CPAP generator's counter. All subjects were asked about their degree of sleepiness before treatment by way of a standard questionnaire. Although most patients reported regular use of CPAP in diaries, only about 60% actually used it for longer than a mean 4.5 hours daily. The most compliant patients could not be differentiated from the least compliant with respect to degree of initial sleepiness, apnea-hypopneaper-hour index or level of CPAP required.

Conclusions

1) the patient's opinion as to degree of compliance with CPAP treatment does not always reflect the real extent of use; 2) Only 60% of our patients used CPAP long enough in the first 3 months of treatment; and 3) Degree of compliance cannot be predicted based on initial sleepiness, level of CPAP required or severity of SAHS. Consequently, procedures for assuring adequate control of CPAP use must be established.

Key words:
Compliance
Syndrome apnea-hypopnea sleep
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Copyright © 1995. Sociedad Española de Neumología y Cirugía Torácica
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