دانلود کتاب پایبندی CPAP – عوامل و دیدگاه ها

We cannot find a more succinct depiction of the status quo of positive airway pressure (PAP) treatment in the twenty-first century than Dickens’ opening line in A Tale of Two Cities, “It was the best of times, it was the worst of times, it was the age of wisdom, it was the age of foolishness.” [1] This is the best of times, in that there have been phenomenal developments in the usability, comfort, individualized and automated feedback of usage, as well as insurance coverage for PAP treatment in many jurisdictions. At the same time, it is the worst of times, because despite the technological advancements, the overall rate of PAP usage among those who would benefit is still low. Recent publications question the benefit of PAP treatment on health outcomes based in part on data derived from samples with low PAP use. At the same time, there is still an insufficient recognition of sleep apnea in the medical field with only minor mention of sleep medicine in medical curricula. A review a decade ago described the mode of CPAP adherence as 50% in clinical research studies, though one suspects that in community clinics the mode is lower [2]. The criterion for “compliance” in these studies was generally set as CPAP use of at least 4 hours, four nights per week. In 2016, a large study found that CPAP use did not help with cardiovascular well-being [3]. However, the average nightly CPAP use was only slightly over 3 hours, and we suspect this low usage covered a very small percentage of REM sleep which comes towards the end of the night and often has the highest frequency of apneic events. It is plausible that REM sleep may be particularly significant in relation to cardiovascular well-being given the autonomic changes during this stage of sleep. The short duration of nightly CPAP use in this study raises questions about the veracity of the general conclusions.