Adherence to Positive Airway Pressure Therapy in Patients With Obstructive Sleep Apnea

Abstract

Adherence to either continuous positive airway pressure (CPAP) or bilevel positive airway pressure (BiPAP) therapy in patients with obstructive sleep apnea syndrome (OSAS) represents a real challenge to sleep medicine physicians. Many risk factors/predictors for nonadherence exist, and usually, it is multifactorial. Long-term nonadherence with CPAP therapy has been associated with the use of CPAP for <4 hours/night during early treatment, moderate to severe obstructive sleep apnea (OSA), poor self-efficacy, and unsupportive bed partner. The American Academy of Sleep Medicine (AASM) recommends follow-up of patients with OSA within the first two weeks of CPAP use to optimize adherence. Measures to improve adherence to positive airway pressure (PAP) therapy go through an integrated approach that involves behavioral therapy and prompt management of side effects. Pharmacologic therapy in the form of a sedative-hypnotic sleep aid has a minor role in managing nonadherence to CPAP based on the greater risk of side effects. This article will briefly discuss the risk factors and management of nonadherence to PAP therapy in patients with OSAS.

Right Versus Left Cuff Position for Upper Airway Stimulation

“…However, many patients experience intolerance with CPAP therapy, thereby reducing adherence and subsequently increasing the risk of developing comorbidities 6,7 . CPAP adherence is defined as using the device for at least 4 h/night 8,9 . Given generally poor compliance with CPAP, upper airway stimulation (UAS) can be offered as an alternate treatment modality 7 .…”

“…6,7 CPAP adherence is defined as using the device for at least 4 h/night. 8,9 Given generally poor compliance with CPAP, upper airway stimulation (UAS) can be offered as an alternate treatment modality. 7 An implantable pulse generator, a stimulation lead (SL), and a breathing sensor line comprise the UAS.…”

The relationship between adherence to continuous positive airway pressure and nasal resistance measured by rhinomanometry in patients with obstructive sleep apnea syndrome

“…The poor adherence group might be affected by the inclusion of the phenotype, which was characterized by severe OSA, high BMI (28-38 kg/m 2 ), low hypoxemia, ESS score (9-10), and low CPAP adherence [37]. In addition, if the effect of CPAP is insufficient and the residual AHI is high, the patient cannot experience the therapeutic effect of CPAP, which in turn favors poor CPAP adherence [19,38]. Therefore, monitoring the therapeutic effect is crucial.…”

“…The initial period of CPAP introduction is central for establishing CPAP adherence [16,17], and adherence during the first month is a predictor of future adherence levels [18]. Furthermore, factors affecting CPAP adherence include patient characteristics (age, nasal cavity volume and nasal resistance, level of understanding of CPAP, self-efficacy, and presence of a bed partner) and medical factors (operability of CPAP equipment, adverse events due to use of CPAP mask interface systems and high pressure during CPAP use, disease requiring long-term treatment [associated with non-radical therapy], CPAP setting and effectiveness, treatment-related factors such as cost, communication between patients and medical staff, patient education, cognitive behavioral therapy, and remote monitoring and/or telephone intervention) [7,14,15,19]. Among these factors, the improvement of nasal resistance by topical treatment contributes to an increase in life quality, but does not ameliorate the apnea-hypopnea index (AHI) [20,21] or affect the severity of OSA.…”

Exploring the Impact of Positional Sleep Apnea in a Turkish Population: Unveiling the Untold Story

“…In addition, since the POSA definition addresses a large OSA patient population, the e-POSA definition has been widely preferred for defining patients that would particularly benefit from PT devices and automatic PAP devices [ 13 , 14 , 16 ]. In this regard, given that PAP adherence remains a major problem in OSA patients, POSA patients treated with CPAP can also have low adherence, and thus may be confronting unwanted cardiometabolic consequences [ 13 , 18 , 19 ]. In contrast, although they represent young populations with mild OSA severity, e-POSA patients that are exposed to significant hypoxic burden may be underestimated and undertreated [ 2 , 7 , 9 , 12 , 13 ].…”