One of the most deadly consequences of sleep apnea is heart failure. Many people who find themselves in the hospital with heart failure find that they have been living with undiagnosed sleep apnea. There is hope that coming to the hospital and getting their sleep apnea diagnosis could help them get effective, lifesaving treatment. Treating sleep apnea after a heart failure can reduce the risk of additional hospitalization and even death.
Many heart failure patients are prescribed CPAP. Unfortunately, though, it seems that CPAP is poorly suited to providing that treatment. A new study shows that less than 30% of heart failure patients keep using CPAP for a full year.
Looking at Compliance in a Hospital Setting
The point of this study was to determine whether diagnosing sleep apnea and prescribing CPAP in a hospital setting significantly changed CPAP compliance. We know that CPAP compliance is relatively low. Some studies show compliance rates of up to 70%, but most hover around 50%. Some are even as low as 16%!
But since most people who are prescribed CPAP get it in an outpatient setting, researchers wanted to know how well patients would comply with treatment prescribed in a hospital setting. To test this, they looked at 91 patients prescribed CPAP in the hospital after experiencing heart failure. Of these patients 81 agreed to use CPAP and began treatment.
Compliance treatment was monitored at three, six, and 12 months. The initial compliance rate at three months was 52%. That rate dropped off significantly by six months to only 37%. By a year after starting CPAP, the compliance rates dropped again to only 27%. If we factor in the initial ten who didn’t agree to treatment with CPAP, the percentage of heart failure patients who benefited from CPAP was less than a quarter: 24%!
The silver lining to this cloud is that those who had good compliance rates at three months had better survival and recovery rates.
Can Oral Appliances Help?
Getting successful sleep apnea treatment for these patients is literally a matter of life or death. We need to know whether oral appliances can help these patients who are not being well served by CPAP. With higher compliance rates (perhaps 95% when measured like CPAP), there is a chance that heart failure patients could get better results with oral appliances.
But oral appliances also might not be as good because heart failure patients often have some degree of central sleep apnea as well as obstructive sleep apnea. Oral appliances can’t treat central sleep apnea. The tradeoff between not treating central sleep apnea and improved compliance should be worked out, which requires focused studies.
But if you have obstructive sleep apnea, oral appliance therapy can help you get better results. Instead of trying to make CPAP work for you, it’s good to try the more comfortable and convenient oral appliances.