Patients treated with positive airway pressure for OSA report adverse effects, mask issues

Key takeaways:

• Some patient-endorsed issues related to positive airway pressure therapy differed based on adherence.
• Nonadherent patients experienced more endorsed issues on day 5, 10 and 30 of therapy.

Around 20% of patients with obstructive sleep apnea starting positive airway pressure reported dry throat/mouth, waking too early and mask discomfort as bothersome issues of the therapy, according to research presented at SLEEP 2024.

Using a novel, electronic 31-item Triage Tool questionnaire, Bruno Saconi, PhD, MA, RN, adjunct assistant professor and lecturer at University of Pennsylvania and nurse scientist at Geisinger, and colleagues assessed responses from 150 patients (mean age, 48 years; 58% men; apnea-hypopnea index, 41.1 events/hour) with moderate to severe OSA who began positive airway pressure (PAP) therapy to find out issues they have with the treatment 5, 10 and 30 days after the start of use.

Researchers asked patients about pressure, mask/device, disturbed sleep, psychosocial and unintentional issues/problems, as well as adverse effects by having them rate how much an issue bothers them on a scale of 1 (not at all) to 4 (a lot).

At day 5, 63% of patients responded to the questionnaire, and this was higher than the rates at day 10 (60%) and day 30 (50%).

The cohort was almost evenly split when divided based on PAP adherence, with 73 patients classified as adherent (at least 70% usage, at least 4 hours over 30 days) and 77 classified as nonadherent.

More individuals belonging to the adherent vs. nonadherent group responded to the questionnaire (overall response rate, 70.3% vs. 45.9%).

Compared with adherent patients, nonadherent patients experienced more patient endorsed issues, defined as responses scored 3 or 4, at day 5 (average, 4.1 vs. 3.4), day 10 (3.9 vs. 2.8) and day 30 (2.5 vs. 2.2).

In the total population, 21% of patients scored dry throat/mouth as a bothersome issue. Other issues scored 3 or 4 by more than 10% of patients included waking too early (20%), mask discomfort (19%), nasal congestion (18%) and difficultly initiating sleep (16%).

Researchers found five other endorsed issues among those classified as nonadherent to PAP: difficulty falling asleep (23%), embarrassment about appearance (23%), concern about appearance (23%), difficulty staying asleep (19%) and waking with mask off (19%).

Notably, traveling with PAP was a concern within the adherent group (20%).

“Identifying specific treatment-related problems experienced by individuals may guide targeted interventions,” Saconi and colleagues wrote. “Further psychometric evaluation is underway to refine the [Triage Tool] questionnaire.”