I will keep beating this horse to death, but the vast majority of those who cannot tolerate CPAP are improperly titrated and/or have a mask that isn't right for them and/or are having leaks. Often all of the above.
That 4 hours is just another symptom of a medical establishment that's not interested in treating patients, but is only interested in numbers. If you want maximum benefits from CPAP, you have to wear it all night every night. If you can't do that, there's a problem that needs to be addressed.
It would be more accurate to say that 40% of people who are offered CPAP are not receiving proper guidance and followup. This is not their fault. This is not CPAP's fault. This is one of medicine's biggest failures.
And yeah, UARS is an entirely different shitshow. It's finally starting to be recognized, hopefully that will lead to improvements for patients.
I don't know why you're so insistent that anybody who can't tolerate CPAP its a titration or fitment issue. I've talked to people who have loads of interaction with sleep doctors, mask fitment specialists, trying different CPAP/AutoPAP/BiPAP/auto-titration settings and I'm one of them. I'm glad medical science is pursuing other treatments that can help the 40% who can't tolerate CPAP and maybe help some of those who don't want to be tethered to a machine every night.
Because it usually is an issue of titration or mask fit.
There are some cases of people have complex sleep apnea, or having awfully non-compliant airways that require uncomfortably high pressures. But the vast majority of people can tolerate PAP just fine.
There are certainly improvements to be made. And thankfully some of them are being worked on (e.g. VCOM or KPAP). And some people could benefit from bilevel or even ASV, and it's a shame that those are often way harder to get. But even if we're being generous, the article's suggestion of 22% of patients who can get by on just the drugs is incredibly underwhelming compared to PAP.
>Because it usually is an issue of titration or mask fit.
I think it may be in some cases, but not the majority. Talking to my sleep doctor recently I don't think she thinks so either. She starts everyone out on AutoPAP with 5-20 ramp as the standard now. Either way I think people who can't tolerate CPAP will welcoming having a drug as an option before more extreme measures like the Inspire device and Maxillomandibular advancement.
That 4 hours is just another symptom of a medical establishment that's not interested in treating patients, but is only interested in numbers. If you want maximum benefits from CPAP, you have to wear it all night every night. If you can't do that, there's a problem that needs to be addressed.
It would be more accurate to say that 40% of people who are offered CPAP are not receiving proper guidance and followup. This is not their fault. This is not CPAP's fault. This is one of medicine's biggest failures.
And yeah, UARS is an entirely different shitshow. It's finally starting to be recognized, hopefully that will lead to improvements for patients.