The Victorian CPAP program: is there a need for additional education and support?

BACKGROUND: The Victorian Continuous Positive Airways Pressure (CPAP) Program provides CPAP services to financially disadvantaged individuals with moderate to severe sleep apnoea. AIMS: To evaluate health outcomes in patients referred to the pilot program in order to: (i) assess the magnitude of health benefit from treatment in this highly selected population and (ii) identify patient characteristics or factors related to service provision that may influence outcome. METHODS: We adopted a simple before-after research design. Patients who were referred to the program were recruited from five sleep centres. Questionnaires were administered at baseline and 1 and 3 months after commencing CPAP. Generic and disease-specific quality of life were assessed using the MOS 36-Item Short-form Health Survey and the Sleep Apnoea Quality-of-life Index, respectively. Subjective daytime sleepiness was measured using the Epworth Sleepiness Scale and the Sleep-Wake Activity Inventory. RESULTS: Of the 68 subjects enrolled in the study, 59 were available for follow up. There were significant improvements in daytime sleepiness (P < 0.0005). Treatment-related symptoms had a negative impact on overall disease-specific quality of life, however there were significant improvements in all other domains of disease-specific quality of life (P < 0.0005). Improvements in generic quality of life were small but statistically significant (P < 0.05). Hospital, disease severity, baseline sleepiness, gender and CPAP-machine type were not predictors of outcome (P > 0.05). CONCLUSION: This review of the Victorian CPAP Program identified significant improvements in subjective daytime sleepiness and quality of life, despite the negative impact of treatment-related symptoms. Future research should explore whether services can be modified to help reduce the impact of treatment-related side-effects.