Background: Heated humidifiers (HH) enable effective treatment of upper airway dryness during nasal continuous positive airway pressure (nCPAP) therapy for obstructive sleep apnoea (OSA), but the role of prophylactic use of HH during the initiation of nCPAP treatment has not been studied so far. Objectives: The aim of the present study was to investigate whether prophylactic HH during the initiation of CPAP would result in improved initial patient comfort and acceptance. Methods: In 44 consecutive, previously untreated OSA patients with no history of upper airway dryness, CPAP titration with and without HH was performed on two consecutive nights in a randomised order. The patients were interviewed after each treatment night in order to establish the comfort of the treatment, and, after the second treatment, they were asked which of the two nights they considered more pleasant, and which treatment they would prefer for long-term use. Results: Following CPAP titration with HH, 32 patients (73%) claimed to have had a better night’s sleep than usual (i.e. without CPAP treatment) compared with 33 patients (75%) saying the same following CPAP treatment without HH. For 21 patients (47.7%) treatment with HH was more pleasant, 23 (52.3%) saw no difference or said that treatment without HH was more pleasant. Nineteen patients (43.2%) gave preference to treatment with HH for long-term use, while 25 patients (56.8%) had no preference or said they would prefer treatment without HH. Conclusions: The use of HH during the initiation phase of CPAP treatment was associated neither with an initial improvement in comfort nor with greater initial treatment acceptance.

1.
Sullivan CE, Issa FQ, Berthon-Jones M, Eves L: Reversal of obstructive sleep apnea by continuous positive airway pressure applied through the nares. Lancet 1981;i:862–865.
2.
Strollo PJ Jr, Rodgers RM: Obstructive sleep apnea. N Engl J Med 1996;334:99–104.
3.
Pepin JL, Leger P, Veal D, Langevin B, Robert D, Levy P: Side effects of nasal continuous positive airway pressure in sleep apnea syndrome. Chest 1995;107:375–381.
4.
Meslier N, Lebrun T, Grillier-Lanoir V, Rolland N, Henderick C, Sailly JC, Racineux JL: A French survey of 3,225 patients treated with CPAP for obstructive sleep apnoea: Benefits, tolerance, compliance and quality of life. Eur Respir J 1998;12:185–192.
5.
Engleman HM, Martin SE, Douglas NJ: Compliance with CPAP therapy in patients with the sleep apnoea/hypopnoea syndrome. Thorax 1994;49:263–266.
6.
Rolfe I, Olson G, Saunders NA: Long-term acceptance of continuous positive airway pressure in obstructive sleep apnea. Am Rev Respir Dis 1991;144:1130–1133.
7.
Grunstein RR: Sleep-related breathing disorders. 5. Nasal continuous positive airway pressure treatment for obstructive sleep apnoea. Thorax 1995;50:1106–1113.
8.
Sanders M, Gruendl C, Ullrich HU: Patient compliance with nasal CPAP therapy for sleep apnea. Chest 1986;90:330–333.
9.
Rauscher H, Formaneck D, Popp W, Zwick H: Self-reported vs measured compliance with nasal CPAP for obstructive sleep apnea. Chest 1993;103:1675–1680.
10.
Hoffstein V, Viner S, Mateika S, Conway J: Treatment of obstructive sleep apnea with nasal continuous positive airway pressure. Patient compliance, perception of benefits, and side effects. Am Rev Respir Dis 1992;145:841–845.
11.
Waldhorn RE, Herrick TW, Nguyen MC: Long-term compliance with nasal continous positive airway pressure therapy of obstructive sleep apnea. Chest 1990;97:33–38.
12.
Wiest GH, Lehnert G, Brueckl WM, Meyer M, Hahn EG, Ficker JH: A heated humidifier reduces upper airway dryness during continuous positive airway pressure therapy. Respir Med 1999;93:21–26.
13.
Wiest GH, Fuchs FS, Brueckl WM, Nusko G, Harsch IA, Hahn EG, Ficker JH: In vivo efficacy of heated and non-heated humidifiers during nasal continuous positive airway pressure (nCPAP)-therapy for obstructive sleep apnoea. Respir Med 2000;94:364–368.
14.
Martins de Araujo MT, Vieira SB, Vasques EC, Fleury B: Heated humidification or face mask to prevent upper airway dryness during continuous positive airway pressure therapy. Chest 2000;117:142–147.
15.
Wiest GH, Ficker JH: Humidification during continuous positive airway pressure therapy. Chest 2000;117:925.
16.
Johns MW: A new method for measuring daytime sleepiness: The Epworth sleepiness scale. Sleep 1991;14:540–545.
17.
American Thoracic Society: Indications and standards for use of nasal continuous positive airway pressure (CPAP) in sleep apnea syndromes. Am J Respir Crit Care Med 1994;150:1738–1745.
18.
American Thoracic Society: Indications and standards for cardiopulmonary sleep studies. Am J Respir Crit Care Med 1989;139:559–568.
19.
Rechtschaffen A, Kales A: A Manual of Standardized Terminology, Techniques and Scoring System for Sleep Stages in Human Subjects. Washington, US Government Printing Office, 1968, pp 1–12.
20.
EEG arousals: Scoring Rules and Examples: A preliminary report from the Sleep Disorder Atlas Task Force of the American Sleep Disorders Association. Sleep 1992;15:174–184.
21.
Stradling JR, Barbour C, Pitson DJ, Davis RJ: Automatic nasal continuous positive airway pressure titration in the laboratory: Patient outcomes. Thorax 1997;52:72–75.
22.
Wiest GH, Fuchs FS, Harsch IA, Pour Schahin S, Lampert S, Brueckl WM, Hahn EG, Ficker JH: Reproducibility of a standardized titration procedure for the initiation of continuous positive airway pressure therapy in patients with obstructive sleep apnoea. Respiration 2001;68:145–150.
23.
Massie CA, Hart RW, Peralez K, Richards GN: Effects on nasal symptoms and compliance in sleep apnea patients using continuos positive airway pressure. Chest 1999;116:403–408.
24.
Peterson BD: Heated humidifiers. Structure and function. Respir Care Clin N Am 1998;4:243–259.
25.
Richards GN, Cistrulli PA, Ungar RG, Berthon-Jones N, Sullivan CE: Mouth leak with nasal continuos positive airway pressure increases nasal airway resistance. Am J Respir Crit Care Med 1996;154:182–186.
26.
Wiest GH, Foerst J, Fuchs FS, Schmelzer AH, Hahn EG, Ficker JH: In vivo efficacy of two heated humidifiers used during CPAP-therapy for obstructive sleep apnea under various environmental conditions. Sleep 2001;24:435–440.
27.
Rauscher H, Popp W, Wanke T, Zwick H: Acceptance of CPAP therapy for sleep apnea. Chest 1991;100:1019–1023.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.