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2-week course of sleep aid increases CPAP adherence in OSA patients at 6 months

May 18, 2009

ATS 2009, SAN DIEGO-New research suggests that patients newly diagnosed with obstructive sleep apnea (OSA) who use a short-course of the sleep aid, eszopiclone, when beginning continuous positive airway pressure (CPAP) therapy, are more adherent with therapy in six months.

The findings will be presented at the American Thoracic Society's International Conference in San Diego on May 17.

OSA is a common disorder that leads to multiple adverse effects on health and quality of life. CPAP is recommended as the first-line therapy for most patients with OSA, and has been shown to improve sleep quality, reduce daytime sleepiness and enhance quality of life. Despite its many benefits, however, compliance to CPAP is notoriously poor.

"We know that non-benzodiazepine sedative hypnotics promote sleep onset and continuity. Additionally, they can be safely used in patients with OSA, especially those already using CPAP," said Anita Shah, D.O., author of the study. "To date, the only consistently reliable predictor of long-term use has been compliance with CPAP at treatment initiation. Studies suggest that long-term adherence patterns may be established very early in the course of therapy."

To test whether eszopiclone would improve early CPAP adherence, the researchers conducted a prospective, double-blind, randomized, placebo-controlled trial involving patients newly diagnosed with OSA who were beginning CPAP therapy. A total of 154 patients were recruited into the study and were randomized to receive either eszopiclone or placebo for their first 14 days of CPAP therapy. CPAP adherence was measured weekly for 24 weeks. The study period began the first day of CPAP therapy.

At the conclusion of the study, researchers found significant differences between the eszopiclone group and the placebo group. On average, patients who received eszopiclone used their CPAP devices more nights per week, and for an hour longer per night. Although the sedative hypnotics were used for only two weeks, the increased adherence with CPAP was sustained for the entire six-month study period.

"Because we know that CPAP therapy improves sleep quality, reduces daytime sleepiness, enhances quality of life and may mitigate the excessive risk for cardiovascular events associated with this disorder, this small intervention could represent a profound clinical benefit to these patients," said Christopher Lettieri, M.D., principal investigator. "Given the poor adherence to CPAP therapy in many patients, any simple intervention that can reliably improve adherence should be strongly considered."

This study is part of the CPAP Promotion and Prognosis-The Army Sleep Apnea Program (CPAP ASAP Trial) being conducted at Walter Reed Army Medical Center. The CPAP ASAP Trial will examine multiple outcomes related to therapeutic adherence, health care utilization, co-morbid conditions and quality of life among patients with newly diagnosed OSA.

American Thoracic Society