Obstructive Sleep Apnea (OSA) describes a situation when there are frequent pauses in breathing during sleep due to an obstructed airway. Continuous Positive Airway Pressure (CPAP) is a preferred and effective treatment which is considered to be the gold standard of OSA therapy1.2 . At least 4 hours usage of CPAP is suggested to maintain an effective and long-term therapeutic improvement and reduce the risk of comorbidities associated with untreated OSA3.4.5.6. However, maintaining high compliance with CPAP device could be difficult for some patients. It may lead to the following issues:

proimages/health/Pressure-Ulcer/Compliance_matters/Compliance_matters_概念圖-03.jpg Daytime fatigue and vehicle accidents
OSA patients with poor CPAP adherence may have impaired sleep quality due to the constant interruption of breathing. Sleep fragmentation will cause excessive daytime sleepiness affecting daily life. For example, truck drivers suffering from OSA have higher risk of vehicle accidents by as much as 250% compared to well-rested drivers7 . Thus, the patients compliance of CPAP therapy can increase the effectiveness of the OSA treatment and decrease the incidence of vehicle accidents compared to untreated OSA patients8.9.
OSA related comorbidities and complications
There are several studies10 reported that OSA patients show a high prevalence of the following comorbidities, including cardiovascular diseases (systemic hypertension, coronary artery disease, arrhythmias, ischemic stroke), respiratory diseases (COPD, asthma), and metabolic disorders (diabetes mellitus, dyslipidemia, gout). Also, peptic ulcer disease, gastroesophageal reflux, chronic liver disease, anxiety, insomnia, depression and even higher chances of getting cancer are identified in OSA patient population10.
proimages/health/Pressure-Ulcer/Compliance_matters/Compliance_matters_概念圖-04.jpg Reimbursement regulations (Regional)
The Centers for Medicare and Medicaid Services (CMS) defines an adequate CPAP adherence as using the CPAP device for ≥ 4 h for ≥ 70% of nights (within a 30 consecutive day period)11 . This has become a standard definition and CMS reimburses the costs of long-term CPAP therapy only if the patient is adherent during a 90-day trial12 . Thus, the reimbursement plan would be affected if patients with poor CPAP adherence.

There are many factors that can affect the patients’ compliance of using CPAP8, such as dry nose, nasal congestion and daytime fatigue. In order to solve these problems, Apex can help!
proimages/health/Pressure-Ulcer/Compliance_matters/Compliance-matters-概念圖.pngThere are several technical approaches for increasing patients comfort level while using Apex's CPAP series, such as applying a heated humidifier and turning PVA (Pressure Variation Algorithm) function on. Using a heated humidifier can prevent the nose and mouth dryness and PVA function allows users to breathe out more easily by reducing the air pressure during exhalation. In addition, the cloud-based patient management system of Apex CPAP device offers timely data transmission to connect with medical professionals and patients. Allows medical professionals to monitor patient's sleep data, provide prompt suggestions, improve the clinical process, and save the time of visits.
Furthermore, choosing a suitable mask is one of important considerations for CPAP users in terms of increasing the CPAP compliance13.14.15. In order to have a restful sleep, CPAP users keen to find a mask with its design providing the convenience of wearing a mask, the freedom to change body position during sleep and high comfort level without air leakage issue according to their sleep habit.

Apex provides a variety of CPAP mask options to our customers, including Nasal mask, Full-face mask and Nasal pillow mask. Our masks feature contour fitting cushion, pressure redistribution on cushions, convenient tubing system, quick-released swivel and 3D-shaped headgear. Those characteristics are designed in Apex CPAP masks to provide users a comfortable and enjoyable CPAP therapy experience and sustain high CPAP compliance!

APEX Sleep Therapy



  1. Becker HF, Jerrentrup A, Ploch T. Effect of nasal continuous positive airway pressure treatment on blood pressure in patients with obstructive sleep apnea. Circulation 2003;107:68–73.
  2. Rotenberg, B.W., Murariu, D. & Pang, K.P. Trends in CPAP adherence over twenty years of data collection: a flattened curve. J of Otolaryngol - Head & Neck Surg 45, 43 (2016).
  3. Gay P; Weaver T; Loube D et al. Evaluation of positive airway pressure treatment for sleep related breathing disorders in adults. SLEEP 2006;29(3):381-401.
  4. Pavwoski P, Shelgikar AV. Treatment options for obstructive sleep apnea. Neurol Clin Pract. 2017;7(1):77-85. doi:10.1212/CPJ.0000000000000320
  5. Bradley TD, Floras JS. Obstructive sleep apnoea and its cardiovascular consequences. Lancet 2009;373:82–93.
  6. Kasai, T. and Bradley, T., 2011. Obstructive Sleep Apnea and Heart Failure. Journal of the American College of Cardiology, 57(2), pp.119-127.
  7. Croke, D. (2021). How sleep apnea causes trucking accidents? - FreightWaves. Retrieved 3 February 2021, from
  8. Tregear S, Reston J, Schoelles K, Phillips B. Obstructive sleep apnea and risk of motor vehicle crash: systematic review and meta-analysis. J Clin Sleep Med. 2009 Dec 15;5(6):573-81. PMID: 20465027; PMCID: PMC2792976.
  9. Filtness, A., Reyner, L., & Horne, J. (2011). One night’s CPAP withdrawal in otherwise compliant OSA patients: marked driving impairment but good awareness of increased sleepiness. Sleep And Breathing, 16(3), 865-871. doi: 10.1007/s11325-011-0588-8
  10. Bonsignore, M.R., Baiamonte, P., Mazzuca, E. et al. Obstructive sleep apnea and comorbidities: a dangerous liaison. Multidiscip Respir Med 14, 8 (2019).
  11. Mehrtash, M., Bakker, J., & Ayas, N. (2019). Predictors of Continuous Positive Airway Pressure Adherence in Patients with Obstructive Sleep Apnea. Lung, 197(2), 115-121. doi: 10.1007/s00408-018-00193-1
  12. Billings ME; Kapur VK. Medicare long-term CPAP coverage policy: a cost-utility analysis. J Clin Sleep Med 2013;9(10):1023-1029.
  13. Brill, A., 2014. How to avoid interface problems in acute noninvasive ventilation. Breathe, 10(3), pp.230-242.
  14. Bakker, J., Neill, A. and Campbell, A., 2011. Nasal versus oronasal continuous positive airway pressure masks for obstructive sleep apnea: a pilot investigation of pressure requirement, residual disease, and leak. Sleep and Breathing, 16(3), pp.709-716.
  15. Rowland, S., Aiyappan, V., Hennessy, C., Catcheside, P., Chai-Coezter, C., McEvoy, R. and Antic, N., 2018. Comparing the Efficacy, Mask Leak, Patient Adherence, and Patient Preference of Three Different CPAP Interfaces to Treat Moderate-Severe Obstructive Sleep Apnea. Journal of Clinical Sleep Medicine, 14(01), pp.101-108.
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