When Adherence to CPAP Fails, What Others Options Do We Have? | Patient Case Quiz

A 50-year-old Caucasian male with a history of obesity, poorly controlled hypertension, paroxysmal atrial fibrillation (PAF), diastolic dysfunction, and moderate obstructive sleep apnea (OSA) presents for follow-up in a multi-specialty sleep medicine clinic. His sleep study had an apnea hypopnea index (AHI) of 25 events per hour. He was prescribed continuous positive airway pressure (CPAP) therapy at 10 cm H2O pressure without additional oxygen supplementation. The patient has had the CPAP therapy for six months but has not followed up regularly. He reports having used the CPAP intermittently in the last 90 days. He states, "I just can't get used to the CPAP setup."

Figure 1

Figure 1a

CPAP Usage

His CPAP usage is shown in Figure 1.
Over the last 90 days, CPAP adherence has been sporadic and less than four hours of usage on the nights CPAP was used. CPAP = continuous positive airway pressure.

Despite multiple attempts at adherence for appropriately prescribed CPAP therapy for the diagnosis of moderate OSA, this patient failed to comply with his therapy. He asks, "What other options do we have, and are they worth my time?"

Which of the following would you choose to help manage his OSA and potentially gain the optimal cardiovascular benefit?

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