Continuous positive airway pressure (CPAP) therapy has just been prescribed for a 40-year-old woman who experiences severe obstructive sleep apnea (OSA) syndrome by her sleep physician. She returns to your office, following a week of CPAP use, and complains that she does not like using CPAP because the mask is uncomfortable.
What is the most appropriate next step?
A. Discontinue CPAP
B. Refer the patient for consideration of upper airway surgery
C. Ask the patient to return to her sleep physician’s CPAP clinic
D. Consider management with an oral appliance
E. Order a switch to a smaller mask
Answer and discussion on next page.
Answer: C. Ask the patient to return to her sleep physician’s CPAP clinic
Severe OSA, when left untreated, is associated with a wide array of medical consequences. CPAP is generally regarded as the first-line therapy for this condition when severe. Therefore, all measures should be taken to ensure that patients comply with treatment. It is important to address compliance issues early, since negative experiences, if left unaddressed, can lead to frustration and disenchantment with CPAP, increasing the tendency for noncompliance even further.
Most sleep disorders centers provide the services of therapists working in CPAP clinics who can evaluate issues with the mask or other problems and address them quickly. These services also are provided by durable medical equipment companies, and other parties. Some of the measures that can be utilized in such clinics for patients experiencing discomfort with CPAP include mask and strap adjustment, providing mask application instructions, selecting a different mask, adjustment of CPAP pressure settings including expiratory pressure relief, the addition of heated humidification, among others.
Oral appliances are generally indicated for mild to moderate OSA, and surgery, although a valuable option in the treatment of OSA is generally considered to be a second-line treatment.