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Establishing an evidence base to improve sleep disorder medicine and home ventilation programs that treat patients with chronic obstructive pulmonary disease
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- Author / Creator
- Laratta, Cheryl R.
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Background: Chronic obstructive pulmonary disease (COPD) is a disabling disease associated with high health care utilization. Patients with sleep-related breathing disorders (SRBD) or chronic hypercapnic respiratory failure (CHRF) in addition to COPD have improved health outcomes if they become established on positive airway pressure (PAP) therapy. Here, evidence regarding success becoming established on PAP therapy in patients with COPD is summarized and novel barriers to use of this therapy were explored.
Methods: A systematic review and meta-analysis of available literature quantified the acceptance of and adherence with non-invasive PAP therapy in patients with COPD when prescribed for long-term use at home. Concurrently, a prospective cohort study was conducted to assess barriers to use of PAP therapy in patients with a SRBD and COPD compared to controls with obstructive sleep apnea (OSA).
General Conclusions: After a systematic assessment and synthesis of data from 86 studies, qualitative and quantitative syntheses were performed. Acceptance of PAP therapy in patients with COPD was high, with the proportion of patients who declined or discontinued PAP therapy within one year of prescription was only 14% (95% CI 10-20%). Adherence to newly prescribed PAP therapy was reported in both continuous and dichotomous measures, with participants achieving a median pooled usage of 6.24 hours/day (95% CI 5.80-6.69 h/day). Among included studies, pooled summary estimates had significant heterogeneity. Among studies, the heterogeneity in acceptance and adherence were partially explained by indication for therapy. Clinical variables that were identified as being important to explore heterogeneity in acceptance and adherence were often not reported in detail such as timing of initial follow-up and types of health care providers involved in care. More patients with CHRF secondary to COPD discontinued therapy within one year; however, of those who accepted therapy, use per day was longer when PAP therapy was prescribed for CHRF secondary to COPD than for patients with COPD and a SRBD. Within studies, variables affecting heterogeneity for uptake and use of PAP therapy were sporadically reported and rarely comprehensively assessed.
Pilot data from a prospective cohort study using survey methodology in Albertans explores the acceptance and adherence with PAP therapy in patients with COPD and a SRBD compared to controls with OSA matched for age and body mass index. Twenty-one of 28 recruited patients with COPD and a SRBD and 12 of 26 controls had completed the study at the time of thesis preparation. Of these, the proportion of participants who were able to both accept and adhere to PAP therapy were 65% of the patients with COPD and 33% of matched controls. The adherence to PAP therapy at 6 weeks was 6.02 hours/day in patients with COPD vs 4.62 hours/day in matched controls. A preliminary descriptive analysis of the characteristics of patients successful in accepting and adhering to PAP therapy for both groups is summarized.
Conclusion: The majority of patients with COPD prescribed PAP therapy successfully accept and adhere to therapy; however, significant heterogeneity was observed among studies. The studies within this research program both synthesize available evidence and generate novel data to inform program structure and policy development. Dissemination of these results in peer-reviewed literature has been accomplished and will continue following the thesis defense. Finally, these data will be used to impact local and national policies for the implementation of PAP therapy to increase the probability of success with PAP therapy in patients with COPD. -
- Graduation date
- Fall 2024
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- Type of Item
- Thesis
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- Degree
- Master of Science
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- License
- This thesis is made available by the University of Alberta Library with permission of the copyright owner solely for non-commercial purposes. This thesis, or any portion thereof, may not otherwise be copied or reproduced without the written consent of the copyright owner, except to the extent permitted by Canadian copyright law.