Christopher J. Lettieri, MD; Anita A. Shah, DO; Aaron B. Holley, MD; William F. Kelly, MD; Audrey S. Chang, PhD; Stuart A. Roop, MD; CPAP ASAP (CPAP Promotion and Prognosis—The Army Sleep Apnea Program) Trial
Adherence to short-term continuous positive airway pressure (CPAP) may predict long-term use. Unfortunately, initial CPAP intolerance may lead to poor adherence or abandonment of therapy.
To determine whether a short course of eszopiclone at the onset of therapy improves long-term CPAP adherence more than placebo in adults with obstructive sleep apnea.
Parallel randomized, placebo-controlled trial from March 2007 to December 2008. Randomization, maintained and concealed centrally by pharmacy personnel, was computer-generated using fixed blocks of 10. Referring physicians, investigators, and patients were blinded to the treatment assignment until after the final data were collected. (ClinicalTrials.gov registration number: NCT00612157)
Academic sleep disorder center.
160 adults (mean age, 45.7 years [SD, 7.3]; mean apneaâ€“hypopnea index, 36.9 events/h [SD, 23]) with newly diagnosed obstructive sleep apnea initiating CPAP.
Eszopiclone, 3 mg (nÂ = 76), or matching placebo (nÂ = 78) for the first 14 nights of CPAP.
Use of CPAP was measured weekly for 24 weeks. Adherence to CPAP (primary outcome) and the rate of CPAP discontinuation and improvements in symptoms (secondary outcomes) were compared. Follow-up at 1, 3, and 6 months was completed by 150, 136, and 120 patients, respectively.
Patients in the eszopiclone group used CPAP for 20.8% more nights (95% CI, 7.2% to 34.4%; PÂ = 0.003), 1.3 more hours per night for all nights (CI, 0.4 to 2.2 hours; PÂ = 0.005), and 1.1 more hours per night of CPAP use (CI, 0.2 to 2.1 hours; PÂ = 0.019). The hazard ratio for discontinuation of CPAP was 1.90 (CI, 1.1 to 3.4; PÂ = 0.033) times higher in the placebo group. Side effects were reported in 7.1% of patients and did not differ between groups.
Patients had severe obstructive sleep apnea treated at a specialized sleep center with frequent follow-up; results may not be generalizable to different settings. Patients' tolerance to CPAP and their reasons for discontinuation were not assessed.
Compared with placebo, a short course of eszopiclone during the first 2 weeks of CPAP improved adherence and led to fewer patients discontinuing therapy.
Approaches that improve adherence to continuous positive airway pressure (CPAP) therapy are needed.
In this trial, 160 adults with severe obstructive sleep apnea were randomly assigned to eszopiclone or placebo for the first 14 nights of CPAP. Adherence to CPAP was then measured weekly for 24 weeks. Patients receiving eszopiclone were less likely to discontinue CPAP and used CPAP more nights and for longer periods per night than did patients receiving placebo.
Eszopiclone given during the first 2 weeks of therapy may help improve long-term adherence and use of CPAP in some patients with severe obstructive sleep apnea.
CPAP = continuous positive airway pressure.
GEE = generalized estimating equation.
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Lettieri CJ, Shah AA, Holley AB, Kelly WF, Chang AS, Roop SA, et al. Effects of a Short Course of Eszopiclone on Continuous Positive Airway Pressure Adherence: A Randomized Trial. Ann Intern Med. ;151:696–702. doi: 10.7326/0003-4819-151-10-200911170-00006
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Published: Ann Intern Med. 2009;151(10):696-702.
Emergency Medicine, Pulmonary/Critical Care.
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