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* From the Alexian Brothers Medical Center (Drs. Massie and Hart), Elk Grove Village, IL; Central DuPage Hospital (Ms. Peralez), Winfield, IL; and Respiratory Services (Dr. Richards), Green Lane Hospital, Auckland, New Zealand.
Correspondence to: Clifford A. Massie, PhD, Suburban Lung Associates, 810 Biesterfield Rd, Suite 404, Elk Grove Village, IL 60007; e-mail: CMassie{at}AOL.com
Study objectives: To evaluate the effects of humidification on nasal symptoms and compliance in sleep apnea patients using continuous positive airway pressure (CPAP).
Design: A randomized, crossover design was employed.
Setting: The study was conducted at two suburban community-based hospital sleep laboratories.
Patients: Data were collected on 38 obstructive sleep apnea patients (mean age, 44.1 years) in whom CPAP was a novel treatment.
Interventions: The interventions were heated humidity, cold passover humidity, and a washout period without humidity.
Measurements and results: Patients were titrated with
heated humidity or cold passover humidity in the laboratory and
subsequently initiated on humidity. Objective compliance, self-report
of factors affecting CPAP use, satisfaction with CPAP, feeling upon
awakening, and daytime sleepiness were assessed at the completion of
each 3-week treatment period and a 2-week washout period. Outcome
measures were assessed with one-way analysis of variance followed by
Scheffe post hoc comparisons. Significant main effects
were observed for compliance (F2,37 = 5.2; p = 0.008),
satisfaction with CPAP (F2,37 = 4.5; p = 0.01), and
feeling refreshed on awakening (F2,37 = 4.4; p = 0.02).
A significant decrease in daytime sleepiness was observed between
baseline and each of the conditions (F3,37 = 55.5;
p < 0.0001), but Epworth sleepiness scale scores did not differ
between conditions (all p values > 0.56). CPAP use with heated
humidity (5.52 ± 2.1 h/night) was greater than CPAP use without
humidity (4.93 ± 2.2 h/night; p = 0.008). Compliance differences
were not observed between CPAP use with cold passover humidity and CPAP
use without humidity. Patients were more satisfied with CPAP when it
was used with heated or cold passover humidity (p 
0.05). However,
only heated humidity resulted in feeling more refreshed on awakening
(p < 0.05). No significant differences were observed among the three
groups on the global adverse side effect score
(F2,37 = 2.5; p = 0.09). Specific side effects such as
dry mouth or throat and dry nose were reported less frequently when
CPAP was used with heated humidity compared to CPAP use without
humidity (p < 0.001).
Conclusions: Compliance with CPAP is enhanced when heated humidification is employed. This is likely due to a reduction in side effects associated with upper airway symptoms and a more refreshed feeling upon awakening. Compliance gains may be realized sooner if patients are started with heated humidity at CPAP initiation.
Key Words: compliance • continuous positive airway pressure • humidity • nasal symptoms • obstructive sleep apnea
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