Sedative Use During CPAP Titration Improves Subsequent Compliance. A Randomized, Double-Blinded, Placebo-Controlled Trial. Chest [Chest] Journal article

Background The initial experience with CPAP may predict subsequent compliance. In a retrospective study, we found that premedication with nonbenzodiazepine sedative-hypnotics during CPAP titration polysomnography independently predicted short-term compliance. To validate these findings, we conducted a prospective clinical trial to assess whether premedication with eszopiclone prior to CPAP titration would improve short-term CPAP compliance. Methods Randomized, double-blinded, placebo-controlled trial. Subjects received eszopiclone 3 mg or matching placebo prior to their CPAP titration polysomnography. We compared the quality of CPAP titrations and objective measures of compliance during the first 4-6 weeks of therapy between the two groups. Results We enrolled 117 subjects and 98 completed the protocol (50 eszopiclone and 48 placebo). There were more women in the eszopiclone group, otherwise, groups were similar at baseline. Premedication with eszopiclone significantly improved sleep efficiency (87.8% +/- 5.8% vs 80.1% +/- 10.5%; p = 0.002) and total sleep time (350.9 +/- 33.6 min vs 319.7 +/- 48.7 min; p = 0.007). There was a trend toward improved sleep latency (19.4 +/- 16.1 min vs 31.8 +/- 30.4 min; p = 0.08) and residual obstructive events on the final CPAP pressure (6.4 +/- 7 events/h vs 12.8 +/- 14.6 events/h; p = 0.08) during polysomnography. Eszopiclone significantly improved CPAP compliance. Among those premedicated with eszopiclone, CPAP was used on more nights (75.9% +/- 20.0% vs 60.1% +/- 24.3%; p = 0.005) and for more hours per night (4.8+/-1.5 v 3.9+/-1.8; p = 0.03). Conclusions Premedication with eszopiclone on the night of CPAP titration improved the quality of CPAP titration and led to significantly greater short-term compliance.

Chest [Chest]