Sleep-Wake Cycle Diagnosed by CPAP Compliance Study

A 22-year-old male with autism presents for follow-up of his severe obstructive sleep apnea (apnea-hypopnea index 50/hour). He is currently on continuous positive airway pressure (CPAP) therapy at 8 cm H2O. Patient admits that he does not wear the CPAP every night. According to his mother, he has poor sleep habits, frequently going to bed after midnight and getting up late in the morning, but she cannot give specific times. Patient does not complain of any daytime sleepiness but his mother states he dozes off periodically during the day. Patient is not presently employed or in school. A compliance report is generated and a sample of the report is shown. Figure 1 shows the CPAP usage for the past 7 months. Figure 2 illustrates the night-to-night compliance over a 2-week period. Figure 1 CPAP usage. Figure 2 Night-to-night compliance. In addition to poor compliance, the CPAP compliance report illustrates which of the following sleep-wake cycle patterns? Nonentrained Sleep phase advance Sleep phase delay Irregular Answer—See next page. Answer: C. Sleep phase delay