What questions should be asked during a follow-up with a patient after starting Continuous Positive Airway Pressure (CPAP) therapy?

Essential Questions for CPAP Follow-Up Assessment

The most critical questions during CPAP follow-up should focus on adherence patterns, symptom improvement, and device-related issues to ensure optimal treatment outcomes and reduce mortality and morbidity risks.

Adherence Assessment

• Ask about nightly CPAP usage patterns, specifically how many hours per night the patient uses CPAP and whether they use it whenever they sleep (day or night) 1
• Determine if the patient is using CPAP for at least 4 hours per night on most nights, which is considered the minimum threshold for adherence 1, 2
• Inquire about any nights when CPAP was not used and reasons for non-use 1, 3
• Review objective CPAP usage data from the device tracking system to verify self-reported adherence 1

Symptom Improvement Assessment

• Ask about changes in daytime sleepiness using validated tools like the Epworth Sleepiness Scale (ESS) 1, 4
• Inquire about improvement in presenting symptoms that prompted OSA treatment (e.g., nocturia, headache, sleep fragmentation, insomnia) 1
• Assess for improvements in quality of life using standardized measures like FOSQ (Functional Outcomes of Sleep Questionnaire) or SF-36 1
• Ask about changes in mood, cognitive function, and memory 1, 3
• Inquire about changes in comorbid conditions such as hypertension, diabetes control, or heart failure symptoms 1, 3

Device-Related Issues

• Ask about mask comfort, fit, and any skin irritation or pressure marks 1, 5
• Inquire about mask leaks, especially those that disturb sleep or affect the eyes 1, 5
• Ask about pressure-related complaints such as difficulty exhaling, chest discomfort, or aerophagia (air swallowing) 5
• Assess for nasal congestion, dryness, or other upper airway symptoms 5
• Inquire about noise issues from the device affecting the patient or bed partner 5

Troubleshooting Common Problems

• If the patient reports mask discomfort or leaks, ask specific questions about when these occur and their severity 1, 5
• For patients reporting pressure intolerance, ask about timing (initial falling asleep vs. middle of night) and nature of discomfort 5
• If adherence is suboptimal, ask about specific barriers to use (e.g., claustrophobia, inconvenience, travel issues) 6
• For patients with residual sleepiness, inquire about sleep duration, sleep hygiene practices, and other sleep disorders 4

Follow-Up Planning

• Ask if the patient has concerns or questions about their CPAP therapy that haven't been addressed 1
• Determine if the patient needs additional education or support for CPAP use 1, 6
• Inquire about any changes in weight, medications, or health conditions that might affect OSA severity or CPAP requirements 1

Important Clinical Considerations

• Early follow-up (within 7-90 days of initiation) is crucial as CPAP adherence patterns are typically established early in treatment 1
• Pressure adjustments have been shown to significantly increase CPAP use (>30 min/night) and should be considered when patients report discomfort 5
• Patients often overestimate their CPAP use, making objective data review essential 1, 7
• Even partial CPAP use (>2 hours/night) with symptom improvement is better than no use, though full-time use during sleep remains the goal 1

Common Pitfalls to Avoid

• Waiting too long for the first follow-up can allow problems to become entrenched, leading to treatment abandonment 1
• Failing to address mask fit and comfort issues promptly, which are among the most common reasons for non-adherence 5, 6
• Not reviewing objective data, as patients typically overestimate their CPAP use 1, 7
• Overlooking residual sleepiness in patients with good adherence, which may indicate inadequate pressure settings or another sleep disorder 4