Noncompliance to Treatment with Positive Airway Pressure - Article Example

Noncompliance to Treatment with Positive Airway Pressure The research d Factors Associated With Noncompliance to Treatment with Positive Airway Pressure by Lin et al., was basically regarding the determination of the threatening factors that may influence patients who were diagnosed with Obstructive Sleep Apnea (OSA) to fail undergoing treatment using Positive Airway Pressure (PAP) due to refusal or objection (Lin et al., 2007). The study had employed a retrospective medical chart review on its design since the information on medical records are valid and were collected by health care provider compared to using research records that are gathered for the sake of giving information (University of Miami, 2007). Thus, the data on the study would be more credible and helpful for its analysis. There are already existing studies made the same with this research but most of it are in Europe and Canada which may not be fit in the urban academic context of US (Lin et al., 2007). This research study of Lin et al., was focused in identifying risk factors for classified patients of OSA who rejects to be treated with PAP in the setting of urban learning of US. OSA is a persistent disorder distinguished by constant contraction or interruption of the continuous inward flow of air when in sleep (Lin et al., 2007). This usually leads to hypoxemia and hypercapnia. The constant attack of nocturnal hypoxemia results to sleep disturbance, daytime hypersomnolence, and various neurobehavioral and cardiopulmonary disorders. According to Lin et al. (2007), OSA has been correlated with the heightened occurrence of cardiovascular diseases which include congestive heart failure, hypertension and cerebrovascular incidents. OSA patients where commonly advised to make some changes when it comes to their behavior which includes, loss of weight, alcohol and sedatives abstinence, sleeping position awareness and sleep hygiene improvement. As a treatment for OSA, PAP is used. Common employment of PAP was through nasal or facial mask. PAP works through an apparatus that opposes negative pressure located in the upper part of the airway which keeps the airway from breaking down (Lin et al., 2007). The main objective of the study is to pinpoint the factors that can threaten OSA patients when they fail to undergo PAP treatment due to disobedience or incorrect process. This research was done in the urban academic context of US. This study wishes to identify that there are factors that endangers OSA patients when they fail to meet the PAP treatment. Though PAP benefits most OSA patients, those who are categorized in the severe stage of the disorder needs to have follow-up in order to discover the treatment's effectiveness. This action allows immediate change of approach in treating the disease. Patients that have been included in the study are those who are already 18 years of age and have been undergoing polysomnography for two times which covers the duration of March 1999 to July 2001 and March 2003 to December 2003. A total of 949 patients were diagnosed with OSA. Patients were selected based on the said period to have a valuable representation of the whole period yet not evaluating the entire charts of 2000. Out of this number, only 131 patients had their complete medical records that were sufficient enough to use for the evaluation of compliance. Compliance in using PAP was determined for about 70% of each observed night with a minimum of four hours usage of PAP. Other patients, though diagnosed to have OSA, were excluded in the research due to their medical records that does not suffice the needed information. Additional reasons include low compliance in PAP due to the poor process and other health concerns such as self-limiting, unclear PAP compliance because follow-up notes were not properly determined, upper airway surgery was done and significant weight loss occurs. In order to recognize the patients who need PAP treatment, researchers based it on the patient's AHI and symptoms. Participants of the study were divided into two. The first group are those who have recorded an AHI greater than 15 irrelevant of the daytime symptoms. The second group are those who have 5-15 AHI with complete record of symptoms. Within the selection of participating patients, sample biases appears. Patients are commonly compliant when they engage in research studies, thus the research's aim of identifying risk factors due to noncompliance will not be achieved. Lin et al., used the Retrospective medical chart review since it is the most suitable and credible design to be utilized in the study. Medical records are used instead of research records because of the validity of the information found in such document. X² was also applied in the study to analyze nominal independent variables while researchers made use of the logistic regression analysis for continuous independent variables. From the 131 examined patients that have participated in the research, 37% or 48 patients were noncompliance in the PAP treatment. The utilization of the logistic regression analysis brought up a positive outcome relationship in a low AHI and noncompliance to PAP which serves as a helpful data for the study. Meanwhile, compliance and other determinants showed no significant equivalence. Noncompliance was identified due to discomfort, rashes in the face and the effect of claustrophobia made by the mask and even nasal and eye irritations because of the pressurized air. This analysis has a few limitations. Initially, number of hours of PAP use was based not on objective data acquired from compliance meters but on self-reporting by patients. Some investigations have manifested that the actual amount of PAP utilized have been repeatedly exaggerated by self reporting. At the time of this analysis, we were restricted by the absence of compliance meters in our institution. This may be a general problem linked with urban sleep centers which are under obligation to hesitation of insurers to pay for the compliance meters. Allocation of PAP devices with compliance meters were now started, and in later studies we will measure compliance based on objective details. Insufficient sample size was another limitation of this study. Unfortunately, this was the effect of the greater rate of patients who were eliminated from the study incurring to partial or missing medical records such as PSG, PAP titration, basic office note, or follow-up medical records. Also, there was a greater rate of patients who were eliminated because they were either unable to check out or did not have permission to the PAP machine. Compliance in available OSA treatments is still a main concern. If this is the case, and the findings on the study shows a significant association between AHI and PAP compliance, it would be possible to make another study that focuses only on PAP compliance and AHI. The result of the study may be a help in determining how OSA patient can be treated using PAP without the issue of noncompliance. Overall, the study of Lin et al., had discovered that aside from the relationship between AHI and PAP compliance, there are no more correlation among other factors. With this result, failure in PAP treatment can be immediately attended to allowing other treatment approach to be given for cases of patients having severe OSA disorder. Increasing number of OSA patients who do not have a continuous or follow-up PAP treatment were very feasible to turn as an urban problem in terms of socioeconomic factor. The result of this study, if given further research, is a potential help in the health care industry. But as long as no concrete method is introduced that can serve better than PAP treatment, it remains an effective therapy for OSA patients though noncompliance is increasing. There are only two references used in this evaluation. The information gathered from Miami University regarding the retrospective medical charts has helped in giving support why it is suitable for the study to use such design. The main study was also utilized, of course, since it was the major source of information. References Lin, Ho-Sheng et al., (2007). Factors associated with noncompliance to treatment with positive airway pressure in Archives of Otolaryngol Head & Neck Surgery Vol. 133, No. 1. USA: American Medical Association. Retrospective Chart Reviews. (2007) In University of Miami online. Retrieved July 17, 2009, from https://eprost.med.miami.edu/ Read More