Comparative Study on CPAP Compliance: PAP-NAP Followed by CPAP Trial vs. CPAP Trial Alone

Liang Chye Goh; Nesha Rajendram; Bryan Way Wern Lim; Jeyanthi Kulasegarah; Revadi Govindaraju; Chun Ian Soo; Chee Kuan Wong

doi:10.1055/s-0045-1806955

Sleep Science, Table of Contents

CC BY-NC-ND 4.0 · Sleep Sci 2025; 18(03): e301-e306
DOI: 10.1055/s-0045-1806955

Original Article

Comparative Study on CPAP Compliance: PAP-NAP Followed by CPAP Trial vs. CPAP Trial Alone

Authors

Liang Chye Goh

¹Department of Otorhinolaryngology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
Nesha Rajendram

¹Department of Otorhinolaryngology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
Bryan Way Wern Lim

³Department of Medicine, School of Medicine, University of Galway, Galway, Ireland
Jeyanthi Kulasegarah

¹Department of Otorhinolaryngology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
Revadi Govindaraju

¹Department of Otorhinolaryngology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
Chun Ian Soo

²Respiratory Unit, Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
Chee Kuan Wong

²Respiratory Unit, Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia

Abstract

Objective

To assess the effectiveness of allocating positive airway pressure nap (PAP-NAP) prior to continuous positive airway pressure (CPAP) trial compared with CPAP trial alone in improving CPAP therapy adherence among individuals diagnosed with obstructive sleep apnea (OSA) in our Southeast Asian cohort.

Materials and Methods

A total of 133 adults with OSA were divided into 2 groups: 1 received PAP-NAP before a CPAP trial, and the other underwent a CPAP trial alone. The correlation between CPAP adherence and polysomnographic data was investigated.

Results

The PAP-NAP group showed better CPAP compliance (above 90%) and adherence (66.64% ± 31.96%) compared with the CPAP-only group (57.90% ± 34.86%). Both groups experienced reductions in apnea hypopnea index (AHI), with the PAP-NAP group having lower residual AHI. Compliance was defined as usage of CPAP > 4H in 14 days.

Conclusion

Positive airway pressure naps prior to a CPAP trial increases short-term CPAP adherence and influences mask selection. Personalized CPAP approaches like PAP-NAP can enhance patient acceptance and motivation. Further research is recommended to investigate long-term adherence.

Keywords

obstructive sleep apnea - CPAP - compliance - adherence - southeastern - Asia

Full Text

References

References
1 Goyal M, Johnson J. Obstructive Sleep Apnea Diagnosis and Management. Mo Med 2017; 114 (02) 120-124
2 Maspero C, Giannini L, Galbiati G, Rosso G, Farronato G. Obstructive sleep apnea syndrome: a literature review. Minerva Stomatol 2015; 64 (02) 97-109
3 Batool-Anwar S, Goodwin JL, Kushida CA, Walsh JA, Simon RD, Nichols DA, Quan SF. Impact of continuous positive airway pressure (CPAP) on quality of life in patients with obstructive sleep apnea (OSA). J Sleep Res 2016; 25 (06) 731-738
4 Mehrtash M, Bakker JP, Ayas N. Predictors of Continuous Positive Airway Pressure Adherence in Patients with Obstructive Sleep Apnea. Lung 2019; 197 (02) 115-121
5 Ballard RD, Gay PC, Strollo PJ. Interventions to improve compliance in sleep apnea patients previously non-compliant with continuous positive airway pressure. J Clin Sleep Med 2007; 3 (07) 706-712
6 Shaukat R, Gamal Y, Ali A, Mohamed S. Adherence to Positive Airway Pressure Therapy in Patients With Obstructive Sleep Apnea. Cureus 2022; 14 (06) e25946
7 Krakow B, Ulibarri V, Melendrez D, Kikta S, Togami L, Haynes P. A daytime, abbreviated cardio-respiratory sleep study (CPT 95807-52) to acclimate insomnia patients with sleep disordered breathing to positive airway pressure (PAP-NAP). J Clin Sleep Med 2008; 4 (03) 212-222
8 Syed Z, Mehta I, Hella JR, Barber K, Khorfan F. Implementing a sleep technician-supervised and personalized APAP interface fitting session prior to initiation of home APAP therapy improves adherence in patients with obstructive sleep apnea. J Clin Sleep Med 2021; 17 (10) 2057-2065
9 Ulibarri VA, Krakow B, McIver ND. The PAP-NAP one decade later: patient risk factors, indications, and clinically relevant emotional and motivational influences on PAP use. Sleep Breath 2020; 24 (04) 1427-1440
10 Hang LW, Huang CS, Cheng WJ. Clinical characteristics of Asian patients with sleep apnea with low arousal threshold and sleep structure change with continuous positive airway pressure. Sleep Breath 2021; 25 (03) 1309-1317
11 Zinchuk A, Edwards BA, Jeon S, Koo BB, Concato J, Sands S. et al. Prevalence, associated clinical features, and impact on continuous positive airway pressure use of a low respiratory arousal threshold among male United States veterans with obstructive sleep apnea. J Clin Sleep Med 2018; 14 (05) 809-817
12 Lam B, Ip MS, Tench E, Ryan CF. Craniofacial profile in Asian and white subjects with obstructive sleep apnoea. Thorax 2005; 60 (06) 504-510
13 Lee RWW, Sutherland K, Sands SA, Edwards BA, Chan TO, Ng SSS. et al. Differences in respiratory arousal threshold in Caucasian and Chinese patients with obstructive sleep apnoea. Respirology 2017; 22 (05) 1015-1021
14 Wang D, Tang Y, Chen Y, Zhang S, Ma D, Luo Y. et al. The effect of non-benzodiazepine sedative hypnotics on CPAP adherence in patients with OSA: a systematic review and meta-analysis. Sleep 2021; 44 (08) zsab077
15 Sunwoo BY, Light M, Malhotra A. Strategies to augment adherence in the management of sleep-disordered breathing. Respirology 2020; 25 (04) 363-371
16 Sawyer AM, Gooneratne NS, Marcus CL, Ofer D, Richards KC, Weaver TE. A systematic review of CPAP adherence across age groups: clinical and empiric insights for developing CPAP adherence interventions. Sleep Med Rev 2011; 15 (06) 343-356
17 Goh KJ, Soh RY, Leow LC, Toh ST, Song PR, Hao Y. et al. Choosing the right mask for your Asian patient with sleep apnoea: A randomized, crossover trial of CPAP interfaces. Respirology 2019; 24 (03) 278-285
18 Giles TL, Lasserson TJ, Smith BH, White J, Cates CJ. Continuous positive airways pressure for obstructive sleep apnoea in adults. Cochrane Database Syst Rev 2006; (01) CD001106
19 Genta PR, Kaminska M, Edwards BA, Ebben MR, Krieger AC, Tamisier R. et al. The Importance of Mask Selection on Continuous Positive Airway Pressure Outcomes for Obstructive Sleep Apnea. An Official American Thoracic Society Workshop Report. Ann Am Thorac Soc 2020; 17 (10) 1177-1185
20 Deng B, Lai F, Zhang M, Xiong C, Chen F, Zhang H. et al. Nasal pillow vs. standard nasal mask for treatment of OSA: a systematic review and meta-analysis. Sleep Breath 2023; 27 (04) 1217-1226