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Worth the effort? Weighing up the benefit and burden of continuous positive airway pressure therapy for the treatment of obstructive sleep apnoea in chronic tetraplegia

Abstract

Study design

Mixed methods

Objectives

Continuous positive airway pressure (CPAP) therapy is the recommended treatment for obstructive sleep apnoea (OSA). The aim of this study was to estimate CPAP adherence in people with tetraplegia and OSA, and to explore the barriers and facilitators to CPAP use.

Setting

Hospital outpatient department in Melbourne, Australia

Methods

People with chronic tetraplegia and OSA were commenced with auto-titrating CPAP and supported for 1 month. Semi-structured interviews were conducted with participants at one month and analysed thematically. CPAP usage was measured at 1, 6 and 12 months, with “adherent” defined as achieving more than 4 h average per night.

Results

Sixteen participants completed the study (80% male; mean age 56 (SD = 15)). Mean nightly CPAP use at one month was 3.1 h (SD = 2.5; 38% adherent), and at 6 months and 12 months were 2.6 h (SD = 2.8; 25% adherent) and 2.1 h (SD = 3.2; 25% adherent). The perceived benefit/burden balance strongly influenced ongoing use. Burden attributed to CPAP use was common, and included mask discomfort, and physical and emotional problems. Adherent participants were motivated by the immediate daytime benefits to mood, alertness and sleepiness. There was a tendency to not recognise symptoms of OSA until after they were treated.

Conclusion

CPAP use is challenging for people with tetraplegia, who experience substantial burden from using the device. When tolerated, the proximate benefits are substantial. People with tetraplegia need more intensive support for longer to help them overcome the burdens of CPAP and benefit from the treatment.

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Acknowledgements

The authors wish to thank ResMed for the donation of the AirSense 10 Autoset devices, and the people with spinal cord injury who generously offered their time to participate in this research.

Author contributions

Study design: MG, SEG, JT, MB, DJB. Participant recruitment and data acquisition: MG, JT, BS, SH, CN, MB. Data analysis and interpretation: MG, SEG, AR, DJB. Manuscript preparation and approval of final version: all authors.

Funding

MG was supported by an Australian Government National Health and Medical Research Council post-graduate scholarship (grant number 1114181) and an Australasian Spinal Cord Injury Network PhD scholarship.

Online supplement

The online supplement contains the following information: additional methods (including participant recruitment and data collection; qualitative analysis and coding framework) and additional results (including individual participant CPAP data; univariate analysis of risk factors for CPAP use; barriers and enablers to CPAP use).

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Conflict of interest

The authors declare that they have no conflict of interest.

Correspondence to Marnie Graco.

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