Acceptance of and six‐month adherence to continuous positive airway pressure in patients with moderate to severe obstructive sleep apnea

Abstract

Background Continuous positive airway pressure (CPAP) is the most effective treatment for moderate to severe obstructive sleep apnea (OSA). Acceptance of and adherence to CPAP are crucial for optimal treatment outcomes. The aim of this study was to investigate the factors influencing patients’ acceptance of and adherence to CPAP treatment. Methods One hundred eighty‐eight patients with moderate to severe OSA who had received CPAP titration from October 2017 to September 2018 were recruited. They were interviewed at 2 weeks and at 6 months to assess CPAP use and barriers to acceptance and adherence. Results One hundred fourteen patients (60.6%) accepted CPAP treatment. Disease severity, assessed by apnea‐hypopnea index (AHI) (odds ratio [OR], 1.05; 95% confidence interval [CI], 1.01‐1.08), subjective satisfaction of titration (OR, 12.83; 95% CI, 3.83‐42.99), initial intention of CPAP therapy (OR, 3.33; 95% CI, 1.05‐10.51) and short‐term home CPAP trial (OR, 9.40; 95% CI, 2.85‐31.08) were associated with acceptance of CPAP treatment. Two‐third of the 98 CPAP acceptors reported good CPAP adherence at 6 months follow‐up. Average hours of CPAP use per day for the first 2 weeks (OR, 1.88; 95% CI, 1.28‐3.04) and the global problems associated with CPAP use (OR, 0.82; 95% CI, 0.73‐0.91) were independent predictors of the six‐month CPAP adherence. Conclusions Nearly 40% of patients with moderate to severe OSA did not accept CPAP treatment, and one‐third of those CPAP acceptors had poor adherence to CPAP treatment. Improvement in disease awareness, comfortable titration experience, short‐term home CPAP trial may be of help to increase CPAP acceptance and early experience with CPAP is important for long‐term adherence. The differences in predicting factors for CPAP acceptance and adherence highlight the importance of focusing on specific aspects during the whole process management of OSA.

Craniofacial Phenotype in Obstructive Sleep Apnea and Its Impact on Positive Airway Pressure (PAP) Adherence

“…In this study, the AHI, RDI, ODI, and AI values were higher in the adherent group, and the nadir SpO 2 was lower, suggesting that OSA was more severe, which is consistent with the results of previous studies. However, there was no significant difference between the patient groups in subjective sleep-related symptoms measured using the PSQI and KESS before treatment, which is also consistent with the results of previous studies [ 2 , 23 ]. However, some studies have reported that changes in sleep symptoms before and after treatment are related to adherence [ 2 ].…”

“…There were no significant differences in age, BMI, underlying diseases, or subjective symptoms. Although sex has been mentioned as a factor influencing adherence to PAP, several studies have not shown consistent results [ 2 , 4 ]. In the case of height, it could not be ruled out that the result was due to the difference in the male to female ratio in each patient group.…”

“…Obstructive sleep apnea (OSA) is a common disease with a prevalence of 2–4% in the adult population [ 1 ] and is associated with excessive daytime sleepiness, reduced quality of life, an increased risk of traffic accidents, and cardiovascular disease [ 2 ].…”

Marketing Factors Associated with a Continuous Positive Airway Pressure Machine Purchasing in Patients with Obstructive Sleep Apnea

“…A scoping review found that CPAP machine treatment gained incremental cost–effectiveness ratios of 16,499 USD with a maximum of 33,119 USD per quality-adjusted life years. Generally, patients with OSA had an acceptance rate for CPAP machine treatment of 48.6–60% [ 45 , 46 ]. The CPAP machine acceptance rate may be higher in some specific population such as Down syndrome (92% after 1 month trial) [ 47 ].…”

“…This study had the average age of 53.86 years which may have higher rate of CPAP machine purchasing. However, this study did not have any interventions which may facilitate CPAP machine acceptance and purchasing such as disease awareness education, comfortable titration experience, or short-term home CPAP trial [ 45 ]. A study from Singapore found that a 1-month CPAP trial may also increase CPAP adherence to 78.5% [ 52 ].…”