eMedicine Specialties > Otolaryngology and Facial Plastic Surgery > Palatal & Maxillofacial Surgery

Snoring and Obstructive Sleep Apnea, CPAP: Follow-up

Author: Vittorio Rinaldi, MD, Resident in Otolaryngology, Department of the Campus Bio-Medico, University of Rome
Coauthor(s): Fabrizio Salvinelli, MD, Professor of Otolaryngology, Campus Bio-Medico, University of Rome; Manuele Casale, MD, Specialist in Otolaryngology, Campus Bio-Medico, University of Rome School of Medicine; Francesco Faiella, MD, Resident in Otolaryngology, Campus Bio-Medico University of Rome School of Medicine; Marco Pappacena, MD, Resident, Department of Otolaryngology, Campus Bio-Medico University, Rome; Karen Hall Calhoun, MD, William E Davis Professor and Chair, Department of Otolaryngology-Head and Neck Surgery, University of Missouri
Contributor Information and Disclosures

Updated: Oct 6, 2008

Follow-up

Further Outpatient Care

  • The n-CPAP does not cure or alter the underlying obstructive sleep apnea (OSA) but rather provides daily relief from the apneas, snoring, hypoxias, and consequent daytime symptoms. After long-term n-CPAP use, a carry-over effect is often noted; therefore, polysomnography results on the first day or two off n-CPAP look remarkably improved. However, this carry-over is short lived, and usually within a week, the snoring, apneas, hypoxias, and daytime symptoms have returned to their original level.
  • n-CPAP is highly successful in treating obstructive sleep apnea (OSA), as long as it is used. Unfortunately, compliance with n-CPAP use is not great, with use for at least 4 hours a night on 5 of 7 nights occurring in only about one half of patients. For this reason, regular follow-up visits are mandatory for ensuring continued successful treatment.
  • Some physicians see patients on a 3- to 4-month basis during their first year of n-CPAP use and yearly thereafter. Repeat sleep studies are obtained after major weight loss or gain or after major change in daytime symptoms. Many patients happily and successfully use the n-CPAP for years. Others find sustained use impossible. These are the patients for whom surgery may be helpful.
  • Even snorers whose polysomnogram does not show sleep-disordered breathing (SDB) should be monitored periodically because they can progress to sleep-disordered breathing (SDB) with time, even without weight gain.
  • The Epworth sleepiness scale is as follows:
    • The patient is instructed to rate the chance of dozing off in each of these situations. They are to choose the most appropriate ranking for each of these situations, working out how they would probably respond if it is something they have not actually done recently. The following is the scoring for this scale:

0 - Would never doze off
1 - Slight chance of dozing off
2 - Moderate chance of dozing off
3 - High chance of dozing off

  • Score situation

_____ Sitting and reading

_____ Watching TV

_____ Sitting inactive in a public place (eg, theater, meeting)

_____ As a passenger in a car for an hour without break

_____ Lying down to rest in the afternoon when circumstances permit

_____ Sitting and talking to someone

_____ Sitting quietly after a lunch without alcohol

_____ In a car, while stopped for a few minutes in the traffic

_____ Total

Patient Education

For excellent patient education resources, visit eMedicine's Sleep Disorders Center. Also, see eMedicine's patient education articles Snoring and Narcolepsy.

 
Acknowledgments

Special thanks go to Dr. Stefano Rinaldi and Dr. Maria Virgilia De Merulis.



More on Snoring and Obstructive Sleep Apnea, CPAP

Overview: Snoring and Obstructive Sleep Apnea, CPAP
Differential Diagnoses & Workup: Snoring and Obstructive Sleep Apnea, CPAP
Treatment & Medication: Snoring and Obstructive Sleep Apnea, CPAP
Follow-up: Snoring and Obstructive Sleep Apnea, CPAP
References
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Further Reading

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Keywords

CPAP, apnea, sleep apnea, snoring, obstructive sleep apnea, sleep apnea snoring, obstructive sleep apnea syndrome, OSAS, upper airway obstruction occurring during sleep, sleep-disordered breathing, SDB, upper airway resistance syndrome, UARS, laryngopharyngeal reflux, insomnia, daytime somnolence, narcolepsy, nasal continuous positive airway pressure, n-CPAP, CPAP machine, CPAP machines, CPAP masks, CPAP mask, CPAP apnea, CPAP sleep, sleep apnea treatment, sleep, snore, sleep apnea machine, apnea treatment, sleep disorder

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Contributor Information and Disclosures

Author

Vittorio Rinaldi, MD, Resident in Otolaryngology, Department of the Campus Bio-Medico, University of Rome
Disclosure: Nothing to disclose.

Coauthor(s)

Fabrizio Salvinelli, MD, Professor of Otolaryngology, Campus Bio-Medico, University of Rome
Disclosure: Nothing to disclose.

Manuele Casale, MD, Specialist in Otolaryngology, Campus Bio-Medico, University of Rome School of Medicine
Disclosure: Nothing to disclose.

Francesco Faiella, MD, Resident in Otolaryngology, Campus Bio-Medico University of Rome School of Medicine
Disclosure: Nothing to disclose.

Marco Pappacena, MD, Resident, Department of Otolaryngology, Campus Bio-Medico University, Rome
Disclosure: Nothing to disclose.

Karen Hall Calhoun, MD, William E Davis Professor and Chair, Department of Otolaryngology-Head and Neck Surgery, University of Missouri
Karen Hall Calhoun, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngic Allergy, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Head and Neck Society, American Medical Association, American Rhinologic Society, Association for Research in Otolaryngology, Society of University Otolaryngologists-Head and Neck Surgeons, Southern Medical Association, Texas Medical Association, and Texas Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Jack A Coleman, MD, Consulting Staff, Franklin Surgical Associates
Jack A Coleman, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngic Allergy, American Academy of Otolaryngology-Head and Neck Surgery, American Academy of Sleep Medicine, American Bronchoesophagological Association, American College of Surgeons, American Laryngological Rhinological and Otological Society, American Society for Laser Medicine and Surgery, and Association of Military Surgeons of the US
Disclosure: Influent  None Review panel membership; accarent, inc Honoraria Speaking and teaching

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Robert M Kellman, MD, Professor and Chair, Department of Otolaryngology and Communication Sciences, State University of New York, Upstate Medical University
Robert M Kellman, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American College of Physician Executives, American College of Surgeons, American Medical Association, American Society for Head and Neck Surgery, and Medical Society of the State of New York
Disclosure: GE Healthcare Honoraria Review panel membership

CME Editor

Christopher L Slack, MD, Otolaryngology-Facial Plastic Surgery, Private Practice, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders
Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association
Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA, Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine
Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society
Disclosure: Covidien Corp Consulting fee Consulting; US Tobacco Corporation unstricted gift unknown

 
 
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