Optimising compliance with CPAP therapy for the treatment of OSA in tetraplegia patients: experience gained from the COSAQ research project at the NSIC

Background: Studies have shown that obstructive sleep apnoea (OSA) is very common in the first year after cervical spinal cord injury, affecting up to 80% of patients. Continuous positive airway pressure (CPAP) overnight is the recognized treatment for OSA, but even in the general population compliance with therapy is a problem. Individuals with cervical spinal cord injury face additional challenges arising from reduced hand function limiting their ability to adjust the CPAP mask, and the need to be able to speak clearly to maintain verbal independence.

Methods: The COSAQ research project is investigating the use of CPAP to treat OSA in newly injured Quadriplegics. CPAP usage by patients participating in the project was reviewed. Data was collected regarding ability to tolerate CPAP for at least 4 hours during a 3-night initial assessment. Usage data from Resmed S8 and S9 CPAP machines was also used to assess on-going compliance, as measured by number of nights CPAP was used >4 hours.

Results: Best results for 4 hours CPAP tolerance were obtained by using a nasal pillows mask with or without a chin strap for the first night. Optimal on-going compliance required frequent visits from the CPAP physiotherapist, particularly during the first 2 weeks on CPAP; the opportunity to try a different mask; and an on-going education program for the nursing staff assisting the patients at night.

Conclusions: Experience gained while working on the COSAQ project has enabled us to develop a care pathway for patients undergoing CPAP therapy for OSA in this spinal unit.