eszopiclone is used to help improve adherence to CPAP
- related: Sleep and Sleep Disordered Breathing
- tags: #literature #boards
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There are several well-proven methods to improving adherence to CPAP, including frequent contact with a member of the health-care team (by phone or home visit), cognitive behavioral therapy, and education about the expected benefits of therapy. A meta-analysis has shown that all of these interventions are associated with improved utilization, albeit with fairly low effect sizes. Mitigation of common side effects, including mask leak due to improper mask fitting and aerophagia, can also be helpful. Several randomized controlled studies have demonstrated improvement in CPAP adherence with the short-term (2-6 weeks) use of eszopiclone (choice D is correct). While most providers are not using this intervention routinely, it may be a good option for patients who struggle with adherence early in the course of CPAP utilization. Of note, similar benefits have not been shown for other hypnotic agents, including zolpidem.
The routine addition of heated humidification to CPAP is a longstanding recommendation of the American Academy of Sleep Medicine; it has been hypothesized that this intervention is more effective in patients with nasal congestion and rhinitis, though this has not been definitively shown, and results among studies show inconsistent benefits. Similar data do not exist for cool humidification (choice B is incorrect).
Expiratory pressure relief (EPR) is a feature available on several different CPAP devices, which provides a transient drop in positive airway pressure occurring at the beginning of expiration. While EPR can be of benefit for patients complaining of an inability to exhale against CPAP, no study has shown any effect on longitudinal adherence or functional outcomes (choice A is incorrect). Similarly, empiric use of bilevel pressure has not been shown to improve use of treatment (choice C is incorrect); some recent data suggest modest improvements in average adherence with autotitrating PAP instead of CPAP, but these differences are quite modest (<15 min per night).1