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V. Fabiani, M. Masciangelo, C. Savi, M. Fabiani; Ocular Discomfort, Nocturnal Device Noise and Cervical Pain Reduce Compliance to Cpap Therapy. Invest. Ophthalmol. Vis. Sci. 2010;51(13):6287.
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Continuous positive airway pressure (CPAP) is the treatment of choice for patients with Obstructive Sleep Apnea Syndrome (OSAS), who need to use it chronically every night in order to prevent the severe cerebro and cardiovascular complications of this pathology. Ocular discomfort is commonly reported after using the device. The aim of this study was to determine the impact of ocular symptoms and noise on the compliance to CPAP therapy in patients wearing different types of masks.
We interviewed 859 patients (mean age: 45±12 years) who had been using CPAP for moderate to severe OSAS (BMI: 31±5 kg/m2; RDI = 54±19/h). Individuals with previous ocular surface diseases, contact lens or ocular drug users were excluded from the study. Patients were divided into two groups: 43% (group A) wore facial nasal mask, while the rest 57% (group B) wore an endo-nasal mask. Airway pressure and ventilation volume parameters of CPAP device were set to the same value in both groups; relative humidity and environmental temperature and noise were monitored. Each patient answered a questionnaire to assess their compliance to therapy 12 months after starting the treatment.
As determined by the questionnaire, 25% of patients included in the study stopped using the CPAP device: 42.4% of group A, 57.6% of group B. Among patients included in group A 57.5% of patients complained ocular discomfort, 29.5% nocturnal device noise; 6% both ocular discomfort and device noise, 4.1% cervical pain, 2.9% other reasons. Among patients included in group B, 50.3% complained ocular discomfort, 32.5% nocturnal device noise; 15.2% both ocular discomfort and device noise, 2% other reasons. No statistically significant difference between the two groups was found. All these patients stopped the treatment not later than 8 weeks.
Our results indicate that ocular discomfort and nocturnal device noise are the main reasons for early interruption of CPAP therapy. An improvement in CPAP devices is needed in order to improve the compliance of patients to therapy. Artificial tear eye drops might be a useful tool in order to reduce ocular discomfort.
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